High-Dose Clopidogrel Fails to Reduce Cardiovascular Events After Stenting

In patients with residual high platelet reactivity, increasing the clopidogrel dose conferred no clinical benefit.

Patients with residual high platelet reactivity (HPR) on standard-dose clopidogrel are at increased risk for cardiovascular events after percutaneous coronary intervention (PCI). The GRAVITAS investigators tested the superiority of high-dose clopidogrel over standard-dose clopidogrel for the prevention of cardiovascular events after drug-eluting stenting in patients with on-treatment HPR. Platelet reactivity after PCI was measured by the VerifyNow platelet function test; HPR was defined as ≥230 P2Y₁₂ reactivity units (PRU). The manufacturer of VerifyNow sponsored the study.

Researchers randomized 2214 patients with on-treatment HPR (41% of eligible stent recipients) to high-dose (150 mg daily) or standard-dose (75 mg daily) clopidogrel. The …

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