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Identification of low responders to a 300-mg clopidogrel loading dose in patients undergoing coronary stenting.

Abstract：

BACKGROUND:Although patients undergoing coronary stenting routinely receive dual antiplatelet treatment to reduce the risk of stent thrombosis, this undesired event still occurs. A suboptimal response to clopidogrel treatment (low responders) has been suggested to contribute to stent thrombosis. In the present study, platelet function profiles were assessed in patients undergoing coronary stenting receiving a standard 300-mg clopidogrel loading dose with the aim to identify low clopidogrel responders. MATERIALS AND METHODS:Platelet aggregation was assessed by light transmittance aggregometry following 6 microM ADP stimuli in 48 patients before and 10 min, 4 and 24 h after receiving clopidogrel front-loading. Patients having > or =40% inhibition of platelet aggregation 24 h after clopidogrel administration were defined as normal responders, whereas those having <40% inhibition were low responders. Glycoprotein (GP) IIb/IIIa activation and P-selectin expression were assessed by whole blood flow cytometry following 2 microM ADP stimuli at the same time points. Platelet function profiles were compared between normal and low clopidogrel responders. RESULTS:Twenty-seven patients (56%) were normal responders and 21 (44%) low responders. Baseline GP IIb/IIIa activation was higher in low responders (74.6+/-16.6% vs. 58.2+/-24.5%, p=0.03). Although GP IIb/IIIa activation reduced following clopidogrel front-loading in both groups, it remained increased among low responders at 24 h (58.6+/-21.3% vs. 40.2+/-28.7%, p=0.05) and during the overall study time course (p=0.02). There were no differences in P-selectin expression. CONCLUSIONS:A considerable proportion of patients have an early suboptimal response to a 300-mg clopidogrel loading dose. An increased GP IIb/IIIa activation before intervention may identify this group of patients suggesting the use of a more aggressive antithrombotic treatment in these individuals.

journal_name

Thromb Res

journal_title

Thrombosis research

authors

Angiolillo DJ,Fernandez-Ortiz A,Bernardo E,Ramírez C,Barrera-Ramirez C,Sabaté M,Hernández R,Moreno R,Escaned J,Alfonso F,Bañuelos C,Costa MA,Bass TA,Macaya C

doi

10.1016/j.thromres.2004.07.007

subject

Has Abstract

pub_date

2005-01-01 00:00:00

pages

101-8

issue

1-2

eissn

0049-3848

issn

1879-2472

pii

S0049-3848(04)00385-8

journal_volume

115

pub_type

杂志文章

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Identification of low responders to a 300-mg clopidogrel loading dose in patients undergoing coronary stenting.