Can Adjustment of Clopidogrel Dosing Reduce Ischemic Events After Stent Implantation?

In a small but promising trial, adjusting the loading dose according to platelet reactivity improved clinical outcomes.

In patients undergoing percutaneous coronary intervention, platelet resistance to clopidogrel is associated with recurrent ischemic events. In this prospective, randomized, multicenter study, investigators used an in vitro test for clopidogrel resistance to guide dose adjustment and assessed subsequent clinical events.

Clopidogrel resistance was defined as a vasodilator-stimulated phosphoprotein (VASP)-phosphorylation index >50% after a 600-mg loading dose. Among 406 patients scheduled for PCI, 162 demonstrated clopidogrel resistance. Of these, 84 patients underwent immediate intervention (and thus served as controls), and 78 patients received up to three additional 600-mg boluses of clopidogrel to reduce the VASP index to <50% before PCI. A…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI