| Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting: a single center, randomized, feasibility study | |
| Alternative Title | Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting: a single center, randomized, feasibility study |
| Zhu HongChang1; Li Yi2; Guan ShaoYi2; Li Jing2; Wang XiaoZeng2; Jing QuanMin2; Wang ZuLu2; Han YaLing2 | |
| 2015 | |
| Source Publication | JOURNAL OF GERIATRIC CARDIOLOGY
 |
| ISSN | 1671-5411 |
| Volume | 12Issue:1Pages:23-29 |
| 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 naive 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. |
| Other 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 naive 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. |
| Keyword | PATIENTS SHOWING RESISTANCE ASPIRIN AND/OR RESISTANCE CARDIOVASCULAR EVENTS MYOCARDIAL-INFARCTION CLOPIDOGREL RESISTANCE RESPONSE VARIABILITY PLATELET INHIBITION DRUG-RESISTANCE INCREASED RISK INTERVENTION Acute coronary syndrome Antiplatelet therapy Clopidogrel Coronary stenting |
| Indexed By | CSCD |
| Language | 英语 |
| Funding Project | [National Key Technology R&D Program in the 12th Five-year Plan of China] |
| CSCD ID | CSCD:5333421 |
| Citation statistics | |
| Document Type | 期刊论文 |
| Identifier | http://ir.imr.ac.cn/handle/321006/148942 |
| Collection | 中国科学院金属研究所 |
| Affiliation | 1.Dalian Med University, Affiliated Hosp 2, Dalian 116023, Shandong, Peoples R China 2.中国科学院金属研究所 |
| Recommended Citation GB/T 7714 | Zhu HongChang,Li Yi,Guan ShaoYi,et al. Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting: a single center, randomized, feasibility study[J]. JOURNAL OF GERIATRIC CARDIOLOGY,2015,12(1):23-29. |
| APA | Zhu HongChang.,Li Yi.,Guan ShaoYi.,Li Jing.,Wang XiaoZeng.,...&Han YaLing.(2015).Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting: a single center, randomized, feasibility study.JOURNAL OF GERIATRIC CARDIOLOGY,12(1),23-29. |
| MLA | Zhu HongChang,et al."Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting: a single center, randomized, feasibility study".JOURNAL OF GERIATRIC CARDIOLOGY 12.1(2015):23-29. |
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