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Platelet aggregation according to body mass index in patients undergoing coronary stenting: should clopidogrel
Dominick J Angiolillo1, Antonio Fernández-Ortiz, Esther Bernardo
1Interventional Cardiology Unit-Cardiovascular Institute, San Carlos University Hospital, Plaza Cristo Rey s-n-planta 2N, 28040 Madrid, Spain. dominickjangiolillo@hotmail.com
Insights
Overweight patients undergoing coronary stenting show reduced platelet inhibition after a standard clopidogrel loading dose. Higher doses or additional antithrombotic therapy may be needed for effective platelet aggregation control in these individuals.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis Research
Background:
- Clopidogrel loading dose (LD) is standard for reducing thrombotic events post-coronary stenting (CS).
- Unlike other antithrombotics, clopidogrel LD is not typically weight-adjusted.
- Limited data exist on optimal clopidogrel LD regimens, especially concerning patient weight.
Purpose of the Study:
- To investigate the influence of Body Mass Index (BMI) on platelet response to a 300 mg clopidogrel LD.
- To determine if overweight patients exhibit altered platelet aggregation after clopidogrel LD compared to normal-weight patients.
Main Methods:
- Adenosine diphosphate (ADP)-induced platelet aggregation (PA) was measured in 48 patients undergoing CS on aspirin.
- Patients were stratified into overweight (BMI ≥ 25 kg/m²) and normal-weight (BMI < 25 kg/m²) groups.
- PA was assessed at baseline and 24 hours post-intervention, with analysis of clopidogrel's inhibitory effect.
Main Results:
- Overweight patients had significantly higher PA at baseline, 24 hours, and overall compared to normal-weight patients.
- Suboptimal platelet aggregation inhibition (<40%) occurred in 59% of overweight patients versus 26% of normal-weight patients (p=0.04).
- Elevated BMI was identified as the sole independent predictor of suboptimal platelet response.
Conclusions:
- Overweight status is associated with a diminished platelet response to a standard 300 mg clopidogrel LD.
- Consideration of higher clopidogrel LD or additional antithrombotic agents is warranted for overweight patients undergoing CS.
- Optimizing antiplatelet therapy based on BMI may improve outcomes in patients with coronary stenting.
Background:
A 300 mg clopidogrel loading-dose (LD) is widely used as an adjunct antithrombotic treatment to reduce the risk of thrombotic events early after coronary stenting (CS). Antithrombotic drugs commonly used during percutaneous coronary interventions, such as heparin and platelet glycoprotein IIb/IIIa inhibitors, but not clopidogrel LD, are weight-adjusted, and few data are available on which is the most effective clopidogrel LD regimen. The aim of this study was to assess whether body mass index (BMI) influenced platelet response to clopidogrel LD in patients undergoing CS.
Methods:
Adenosine diphosphate (ADP)-induced platelet aggregation (PA) was assessed by light transmittance aggregometry in 48 patients on aspirin treatment undergoing CS receiving a 300 mg clopidogrel LD at intervention time. PA was assessed at baseline and up to 24 hours after intervention. Patients were divided into 2 groups according to BMI: overweight (BMI greater than or equal to 25 kg/m2; 29 patients) and normal weight (BMI<25 kg/m2; 19 patients). PA was significantly higher in overweight than in normal weight patients at baseline (60.1+/-18.6%; versus 47.6+/-13.5%; p=0.01), at 24 hours (42.3+/-18.4% versus 38.5+/-18.3%; p=0.02) and during the overall study time (p=0.025). Percentage of inhibition of PA 24 hours following clopidogrel LD was suboptimal (<40%) in 59% and 26% of overweight and normal weight patients, respectively (p=0.04). An elevated BMI was the only independent predictor of suboptimal platelet response.
Conclusion:
These data suggest that overweight patients may need a higher loading-dose of clopidogrel and/or an adjunct antithrombotic treatment to adequately inhibit platelet aggregation early after CS.
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