Effects of Intensive Antiplatelet Therapy for Patients With Clopidogrel Resistance After Coronary Stent Implantation

Comparador activo: standard group

patients in this group received standard dual antiplatelet therapy, i.e. aspirin 300mg/d and clopidogrel 75mg/d

Droga: aspirin, clopidogrel

patients in the standard group received standard dual antiplatelet therapy: aspirin 300mg/d for 30 days followed by 100mg/d indefinitely, clopidogrel 75mg/d for at least 1 year

Experimental: intensive group

patients in this group received intensive antiplatelet therapy and the regimen can be adjusted according to results of platelet aggregation function test by LTA

Droga: aspirin, clopidogrel, cilostazol

Firstly,all patients in this group were received aspirin 300mg/d and clopidogrel 150mg/d for 3 days. Then a platelet aggregation function test was performed. The regimen will lasted for another 27 days if patients were judged as responsive to current clopidogrel dose. Patients still with clopidogrel resistance were then randomly assigned to receive clopidogrel 75mg/d plus cilostazol 100mg, twice per day or clopidogrel 150mg/d plus cilostazol 50mg, twice per day for 27 days. At 30-day, a repeat platelet aggregation function test wil performed for all patients. Then a standard dual antiplatelet regimen with aspirin 100mg/d indefinitely and clopidogrel 75mg/d for at least 1 year will be prescribed for all patients.

Major ischemic cardiovascular events

defined as a composite of cardiac death, myocardial infarction or stroke

Stent thrombosis

according to ARC definition

major adverse cardiac and cerebral events(MACCE)

defined as a composite of cardiac death, myocardial infarction, target vessel revascularization or stroke

Hemorrhagic events

according to TIMI bleeding definition

reduction in ADP induced platelet aggregation

assessed by LTA (Packs-4 Aggregometer, Helena labs, Beaumont, Texas)