If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  Tailored Clopidogrel Treatment Reduces Risk of Stent Thrombosis: Presented at AHA By Ed Susman NEW ORLEANS -- November 10, 2008 -- Adding extra doses of clopidogrel to overcome resistance to the regimen appears to significantly reduce the risk of stent thrombosis among patients undergoing catheter-based stent implantation, according to research presented at the American Heart Association (AHA) Scientific Sessions. Franck Paganelli, MD, PhD, Hôpital Nord, University of Marseillle School of Medicine, Marseille, France, presented the results of the Tailored Clopidogrel Loading Dose According to Platelet Reactivity Monitoring to Prevent Stent Thrombosis study in a late-breaking clinical trial session here on November 10. To evaluate the utility of a vasodilator-associated stimulated phosphoprotein (VASP) index to guide management in patients undergoing percutaneous coronary intervention (PCI), Dr. Paganelli and colleagues enrolled 429 patients. All patients received aspirin 250 mg and clopidogrel 600 mg and underwent vasodilator-stimulated phosphoprotein (VASP) screening. Patients with a VASP index of 50% or greater were then randomised to receive routine management or further VASP-guided loading doses of clopidogrel 600 mg until the VASP index was less than 50%, up to a maximum of 3 additional doses per 24 hours. A total of 214 patients received VASP-guided clopidogrel therapy and 215 received standard treatment. Participants in the study were mainly men (80%) aged about 66 years; more than 50% of the subjects had acute coronary syndrome; about 24% received glycoprotein IIb/IIIa inhibitors in addition to aspirin and clopidogrel. Results showed that definite stent thrombosis occurred in 10 patients on standard treatment and 1 patient in the VASP cohort (P = .01). After receiving 2400 mg of clopidogrel, 8% of the patients remained resistant to clopidogrel, Dr. Paganelli said. In fact, the only person in the study to experience definite stent thrombosis within 30 days of treatment was a clopidogrel-resistant patient, he said. All the events in the study occurred within the first week of treatment. Dr. Paganelli said that 19 control patients experienced a major adverse coronary event (4 deaths, 10 heart attacks, 5 urgent revacularisation procedures) compared with 1 event (myocardial infarction) among those who had VASP screening (P < .01 for this secondary endpoint).
[Presentation Title: Tailored Clopidogrel Loading Dose According to Platelet Reactivity Monitoring Decreases Early Stent Thrombosis. Late-breaking clinical trial]
|
