Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting: a single center, randomized, feasibility study

Hong-Chang Zhu, Yi Li, Shao-Yi Guan, Jing Li, Xiao-Zeng Wang, Quan-Min Jing, Zu-Lu Wang, Ya-Ling Han, Hong-Chang Zhu, Yi Li, Shao-Yi Guan, Jing Li, Xiao-Zeng Wang, Quan-Min Jing, Zu-Lu Wang, Ya-Ling Han

Abstract

Background: Low responsiveness to clopidogrel (LRC) is associated with increased risk of ischemic events. This study was aimed to explore the feasibility of tailored antiplatelet therapy according to the responsiveness to clopidogrel.

Methods: A total of 305 clopidogrel naïve patients with acute coronary syndromes (ACS) undergoing coronary stenting were randomly assigned to receive standard (n = 151) or tailored (n = 154) antiplatelet therapy. The ADP-induced platelet aggregation tests by light transmission aggregometry were performed to identify LRC patients assigned to the tailored group. The standard antiplatelet regimen was dual antiplatelet therapy with aspirin and clopidogrel. The tailored antiplatelet therapy was standard regimen for non-LRC patients and an additional 6-month cilostazol treatment for LRC patients. The primary efficacy outcome was the composite of cardiovascular death, myocardial infarction or stroke at one year.

Results: LCR was present in 26.6% (41/154) of patients in the tailored group. The percentage platelet aggregation for LCR patients was significantly decreased at three days after adjunctive cilostazol treatment (77.5% ± 12.1% vs. 64.5% ± 12.1%, P < 0.001). At one year follow-up, a non-significant 37% relative risk reduction of primary events were observed in the tailored group as compared to the standard group (5.8% vs. 9.3%, P = 0.257). There were no differences in the rates of stent thrombosis and hemorrhagic events between the two groups.

Conclusions: Tailored antiplatelet therapy for ACS patients after coronary stenting according to responsiveness to clopidogrel is feasible. However, its efficacy and safety need further confirmation by clinical trials with larger sample sizes.

Keywords: Acute coronary syndrome; Antiplatelet therapy; Clopidogrel; Coronary stenting.

Figures

Figure 1.. Flow chart of the study.
Figure 1.. Flow chart of the study.
ACS: acute coronary syndromes; ASA: acetylsalicylic acid; PA: platelet aggregation; IPA: inhibition of platelet aggregation; T0: before clopidogrel therapy; T1: 24 h after 600 mg clopidogrel loading; T2: three days after cilostazol treatment.
Figure 2.. Laboratory platelet aggregation function assessment.
Figure 2.. Laboratory platelet aggregation function assessment.
(A): patients who received tailored antiplatelet therapy; (B) patients with low responsiveness to clopidogrel in the tailored group. T0: before clopidogrel therapy; T1: 24 h after 600 mg clopidogrel loading; T2: three days after cilostazol treatment.
Figure 3.. Kaplan-Meier assessment of the probability…
Figure 3.. Kaplan-Meier assessment of the probability of a primary event.

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Source: PubMed

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