Author + information
- Received July 3, 2008
- Revision received July 29, 2008
- Accepted August 16, 2008
- Published online December 1, 2008.
- 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† and
- Jean Louis Bonnet, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Thomas Cuisset, CHU Timone, Cardiology, 264 rue Saint Pierre, Marseille 13385, France
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.
This work was supported by the Assistance Publique Hôpitaux de Marseille.
- Received July 3, 2008.
- Revision received July 29, 2008.
- Accepted August 16, 2008.
- American College of Cardiology Foundation