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Increased risk in patients with high platelet aggregation receiving chronic clopidogrel therapy undergoing

Kevin P Bliden1, Joseph DiChiara, Udaya S Tantry

  • 1Sinai Center for Thrombosis Research, Baltimore, Maryland 21215, USA.

Journal of the American College of Cardiology
|February 13, 2007
PubMed

Insights

Patients on clopidogrel with high platelet aggregation before stenting face increased ischemic event risk. This highlights the need for personalized antiplatelet therapy strategies to improve outcomes after coronary interventions.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Heightened platelet reactivity to adenosine diphosphate (ADP) may increase ischemic event risk post-coronary stenting.
  • Chronic clopidogrel therapy is standard for patients undergoing stenting.

Purpose of the Study:

  • To determine if high on-treatment platelet aggregation predicts post-stenting ischemic events in patients on chronic clopidogrel therapy.
  • To assess the role of aggregometry and thrombelastography (TEG) in identifying high-risk patients.

Main Methods:

  • 100 patients on chronic aspirin and clopidogrel therapy undergoing nonemergent stenting were studied.
  • Platelet aggregation was measured pre-stenting using light transmittance aggregometry and TEG.
  • Patients were followed for 1 year for ischemic events (death, MI, stent thrombosis, stroke, or hospitalization for ischemia).

Main Results:

  • 23% of patients experienced ischemic events within 1 year.
  • Higher ADP-induced platelet aggregation (by aggregometry and TEG) was significantly associated with ischemic events (p < 0.001).
  • High platelet reactivity identified 70% (aggregometry) and 87% (TEG) of patients with ischemic events.

Conclusions:

  • High on-treatment platelet aggregation in patients on clopidogrel undergoing stenting is a significant predictor of postprocedural ischemic events.
  • Findings suggest potential for adjusting clopidogrel dosage or using glycoprotein IIb/IIIa inhibitors in high-risk patients.
Abstract

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