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Glycoprotein IIb/IIIa Inhibitors Improve Outcome After Coronary Stenting in Clopidogrel Nonresponders

A Prospective, Randomized Study

Thomas Cuisset, MD^_*,,_*, Corinne Frere, MD, PhD, Jacques Quilici, MD^_*, Pierre-Emmanuel Morange, MD, PhD, Jean-Philippe Mouret, MD^_*, Laurent Bali, MD^_*, Pierre-Julien Moro, MD^_*, Marc Lambert, MD^_*, Marie-Christine Alessi, MD, PhD, Jean Louis Bonnet, MD^_*

^_* Department of Cardiology, CHU Timone, Marseille, France
Inserm, U626, Faculté de Médecine, Laboratoire d'Hématologie, CHU Timone, Marseille, France

^_* Reprint requests and correspondence: Dr. Thomas Cuisset, CHU Timone, Cardiology, 264 rue Saint Pierre, Marseille 13385, France (Email: thomascuisset{at}voila.fr).

Objectives: The aim of this study was to assess, in clopidogrel nonresponders undergoing elective percutaneous coronary intervention (PCI), the benefit of adjusted antiplatelet therapy with glycoprotein (GP) IIb/IIIa antagonist administration during PCI for 1-month clinical outcome.

Background: Numerous biological studies have reported interindividual variability in platelet response to clopidogrel with clinical relevance, and high post-treatment platelet reactivity (adenosine diphosphate-induced aggregation >70%) has been proposed to define nonresponse to clopidogrel. These nonresponders might benefit from tailored antiplatelet therapy.

Methods: One hundred forty-nine clopidogrel nonresponders referred for elective PCI were prospectively included and randomized to "conventional group" (n = 75) or "active group" with GP IIb/IIIa antagonist (n = 74). All patients received 250-mg aspirin and 600-mg clopidogrel before PCI and platelet testing.

Results: The rate of cardiovascular events at 1 month was significantly lower in the "active group" than in the "conventional group": 19% (n = 14) versus 40% (n = 30), p = 0.006, odds ratio: 2.8; 95% confidence interval: 1.4 to 6.0. No patient in either group had post-procedural Thrombolysis In Myocardial Infarction major bleeding or required transfusions.

Conclusions: The present study suggested benefit of tailored antiplatelet therapy during elective PCI with GP IIb/IIIa antagonist for clopidogrel nonresponders without increased bleeding risk.

Key Words: clopidogrel response • coronary stenting • glycoprotein IIb/IIIa antagonist

Abbreviations and Acronyms   ACS = acute coronary syndrome   ADP-Ag = adenosine diphosphate-induced platelet aggregation   CV = cardiovascular   GP = glycoprotein   PCI = percutaneous coronary intervention   PPP = platelet-poor plasma   PRP = platelet-rich plasma   ST = stent thrombosis   VASP = vasodilator-stimulated phosphoprotein

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