Tailored Clopidogrel Loading Dose According to Platelet Reactivity Monitoring to Prevent Acute and Subacute Stent Thrombosis

Bonello, Laurent; Camoin-Jau, Laurence; Armero, Sébastien; Com, Olivier; Arquès, Stéphane; Burignat-Bonello, Caroline; Giacomoni, Marie-Paule; Bonello, R; Collet, F; Rossi, P; Barragan, Paul; Dignat-George, Françoise; Paganelli, Franck

doi:10.1016/j.amjcard.2008.08.048

Cited by 268 publications

(182 citation statements)

References 27 publications

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“…Furthermore, a tailored 600-mg clopidogrel LD according to PRI also prevents acute and subacute ST in the same patients. 22 However, these 2 studies were conducted within 1 month after stent implantation. In the present study, we report that the benefit of VASP-guided clopidogrel therapy lasts for 12 months.…”

Section: Discussionmentioning

confidence: 99%

“…19,20 In order to find a better method to tackle clopidogrel resistance, Bonello et al 21 adjusted the clopidogrel LD according to platelet monitoring using the vasodilator-stimulated phosphoprotein (VASP) index in a multicenter randomized prospective study, and observed that it was safe and significantly improved the clinical outcomes after PCI in patients with clopidogrel resistance. In another study, Bonello et al 22 also demonstrated that tailoring the clopidogrel LD according to platelet reactivity monitoring decreased the rate of early stent thrombosis (ST) after PCI without increasing bleeding. These 2 studies prove the significance of VASP-guided antiplatelet therapy in clopidogrel-resistant patients.…”

Section: Introductionmentioning

confidence: 98%

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Modifying Clopidogrel Maintenance Doses According to Vasodilator‐Stimulated Phosphoprotein Phosphorylation Index Improves Clinical Outcome in Patients With Clopidogrel Resistance

Wang

Dai-fu

Zhuang

et al. 2011

Clinical Cardiology

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Background: Despite dual antiplatelet therapy, the rate of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) remains high. Ex vivo tests of clopidogrel resistance can predict MACE after PCI. The purpose of this study is to evaluate the clinical impact of adjusting phosphorylation analysis in patients with clopidogrel resistance undergoing PCI. Hypothesis: We hypothesized that VASP-guided clopidogrel maintenance doses, compared to fixed doses, improved clinical outcome. Methods: This monocentric, prospective, randomized study was performed on 306 patients undergoing PCI. Patients were randomized to a control group (n = 156) and to a vasodilator-stimulated phosphoprotein (VASP)-guided group (n = 150). In the VASP-guided group, patients received adjusted maintenance doses of clopidogrel to obtain platelet reactivity index (PRI) of <50% during 1 year after PCI. The primary endpoint was the rate of MACE. The secondary endpoints were major and minor bleeding. Results: All patients completed the PCI procedure and 298 patients completed follow-up. The control and VASP-guided groups had similar demographic, clinical, and angiographic characteristics. In the VASP-guided group, PRI was significantly decreased (from 72.1% ± 11.4% to 27.7% ± 8.4%; P = 0.001) in 128 patients (87.1% of all participants). During the 1-year follow-up, 14 MACEs were recorded in the VASP-guided group and 30 MACEs were recorded in the control group (9.3% vs 20.4%, respectively; P = 0.008). There was no difference in the rate of major and minor bleeding in the VASP-guided group compared with the control group (12.9% vs 16.6%; P = 0.06). Conclusions: Modifying clopidogrel maintenance doses according to platelet reactivity monitoring decreases the rate of MACE after PCI without increasing bleeding in patients with clopidogrel resistance during 1-year follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Modifying Clopidogrel Maintenance Doses According to Vasodilator‐Stimulated Phosphoprotein Phosphorylation Index Improves Clinical Outcome in Patients With Clopidogrel Resistance

Wang

Dai-fu

Zhuang

et al. 2011

Clinical Cardiology

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“…It is however unclear whether the level of in vitro platelet activation in stored PCs correlates with in vivo survival and haemostatic function of platelets after transfusion [18]. A special use is to assess the inhibition of the ADP-receptor P2Y12 by clopidogrel in patient blood samples by measuring the degree of phosphorylation of the intracellular protein VASP, which recently has been used to guide dosage of clopidogrel and improved outcome after percutaneous coronary intervention [19].…”

Section: Flow Cytometrymentioning

confidence: 99%

Methods for evaluation of platelet function

Lindahl

Ramström

2009

Transfusion and Apheresis Science

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“…There is increasing evidence that a tailored clopidogrel loading and maintenance dose according to platelet reactivity monitoring may decrease the rate of early stent thrombosis after PCI [15,16]. Whether direct guidance of tailored antiplatelet therapy based on platelet function testing improves the clinical outcome of patients undergoing PCI remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Early double stent thrombosis associated with clopidogrel hyporesponsivenesss

2011

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A 57-year-old male patient without cardiovascular history suffered an acute myocardial infarction and underwent drug-eluting stent implantation in the left anterior descending artery. A few days later, the right coronary artery was also stented (drug-eluting stent). Three days later, he was re-admitted to our hospital in cardiogenic shock. Emergent coronary angiography showed total occlusion of both stents. Platelet function analysis (PFA) showed attenuated platelet inhibition in response to clopidogrel treatment. The patient was the carrier of a loss-of-function polymorphism in the CYP2C19 gene, which has been associated with increased incidence of adverse thrombotic events. Antiplatelet therapy was switched to prasugrel and PFA revealed an adequate antiplatelet effect.

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Tailored Clopidogrel Loading Dose According to Platelet Reactivity Monitoring to Prevent Acute and Subacute Stent Thrombosis

Cited by 268 publications

References 27 publications

Modifying Clopidogrel Maintenance Doses According to Vasodilator‐Stimulated Phosphoprotein Phosphorylation Index Improves Clinical Outcome in Patients With Clopidogrel Resistance

Modifying Clopidogrel Maintenance Doses According to Vasodilator‐Stimulated Phosphoprotein Phosphorylation Index Improves Clinical Outcome in Patients With Clopidogrel Resistance

Methods for evaluation of platelet function

Early double stent thrombosis associated with clopidogrel hyporesponsivenesss

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