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[Effects of intensive antiplatelet therapy in patients with high platelet aggregability after percutaneous coronary
Yan-ling Lu1, Yun-dai Chen, Shu-zheng Lü
1Anzhen Hospital, Capital University of Medical Sciences, Beijing 100029, China.
Insights
Intensive antiplatelet therapy significantly lowered major cardiac events in patients with high platelet aggregability post-PCI. This approach improved outcomes by enhancing platelet inhibition rates and reducing target vessel revascularization.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- High platelet aggregability post-percutaneous coronary intervention (PCI) is linked to increased major cardiac event rates.
- Current antiplatelet therapies may be insufficient for patients with high on-treatment platelet aggregation.
Purpose of the Study:
- To evaluate the efficacy of intensive antiplatelet therapy in patients with high platelet aggregability after PCI.
- To assess the impact of adding cilostazol to standard dual antiplatelet therapy on cardiac events.
Main Methods:
- A randomized controlled trial involving 402 patients with low adenosine diphosphate (ADP)-induced platelet inhibition (<30%) after PCI.
- Patients received either standard dual antiplatelet therapy (clopidogrel and aspirin) or intensive therapy (clopidogrel, aspirin, plus cilostazol) for 6 months.
- Major adverse cardiac events (MACE) were the primary endpoint.
Main Results:
- Intensive therapy significantly improved ADP-induced platelet inhibition rates compared to the control group (9.4% vs. 89.6% after 28 days).
- The treatment group showed a significantly lower rate of target vessel revascularization (6.5% vs. 15.9%) and overall MACE (13.5% vs. 25.4%).
- Rates of thrombosis, death, non-fatal myocardial infarction, and hemorrhage were similar between groups.
Conclusions:
- Intensive antiplatelet treatment, including cilostazol, is effective in reducing major cardiac events in high-risk patients post-PCI.
- This strategy enhances platelet inhibition and lowers the need for revascularization in patients with high on-treatment platelet reactivity.
Objective:
Post percutaneous coronary intervention (PCI) major cardiac event rate is high in patients with high platelet aggregability. We observed the effects of intensive antiplatelet therapy in these patients.
Methods:
ADP-induced platelet inhibition rates were less than 30% after 24 h treatment with Clopidogrel (300 mg) in 402 patients out of 1556 patients who underwent PCI in our institute between January 2004 to June 2006. These patients were randomly divided into control group (Clopidogrel 75 mg/d and aspirin 100 mg/d, n = 201) or treatment group (Clopidogrel 75 mg/d and aspirin 100 mg/d plus cilostazol 200 mg/d, n = 201). Major adverse cardiac events were analyzed after 6 months treatments.
Results:
Patients with ADP-induced platelet inhibition rates < 30% were significantly lower in treatment group compared to control group after 28 days treatments (9.4% vs. 89.6%, P < 0.05). Thrombosis complication (0.5% vs. 3.0%), death (0 vs. 1.0%), non-fatal myocardial infarction (0.5% vs. 1.5%), hemorrhagic (6% vs. 4%) rates were similar between treatment and control group while target vessel revascularization rate was significantly lower in treatment group compared to control group (6.5% vs. 15.9%, P < 0.05). Total MACE rate was therefore significantly lower in treatment group than that in control group (13.5% vs. 25.4%, P < 0.05).
Conclusion:
Intensive anti-platelet treatment could significantly reduce major cardiac event rates in patients with high platelet aggregability after percutaneous coronary intervention.
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