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The EFFect of hIgh-dose ClopIdogrel treatmENT in patients with clopidogrel resistance (the EFFICIENT trial)

Hasan Ari1, Hakan Ozkan, Ali Karacinar

  • 1Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey. hasanari03@yahoo.com

International Journal of Cardiology
|January 18, 2011
PubMed

Insights

High-dose clopidogrel effectively prevents major adverse cardiovascular and cerebrovascular events (MACCE) in patients with clopidogrel resistance after PCI. This intensified treatment did not increase bleeding risk compared to standard doses.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Clopidogrel resistance is a concern in patients undergoing percutaneous coronary intervention (PCI).
  • Standard clopidogrel dosing may be insufficient for patients with resistance.
  • Optimizing antiplatelet therapy is crucial for preventing adverse events post-PCI.

Purpose of the Study:

  • To assess the efficacy of high-dose clopidogrel continuation therapy in mitigating MACCE.
  • To compare high-dose versus standard-dose clopidogrel in patients with demonstrated clopidogrel resistance.
  • To evaluate the safety profile, specifically bleeding risk, associated with high-dose clopidogrel.

Main Methods:

  • A study involving 192 patients undergoing elective PCI.
  • Patients were categorized into a control group (no resistance) and two resistance groups: standard-dose (75 mg/day) and high-dose (150 mg/day) clopidogrel.
  • Clopidogrel resistance was determined using the VerifyNow P2Y12 test; resistance was defined as <40% platelet inhibition.

Main Results:

  • The high-dose group showed a significantly lower event rate for MACCE compared to the standard-dose group (p=0.045).
  • No significant difference in MACCE was observed between the high-dose group and the control group (p=0.82).
  • Bleeding rates and the rate of non-cardiovascular adverse events (NACE) were similar across all treatment groups.

Conclusions:

  • High-dose clopidogrel continuation therapy is more effective than standard-dose therapy in preventing MACCE in patients with clopidogrel resistance post-PCI.
  • Increased clopidogrel dosage did not elevate the risk of bleeding complications.
  • The EFFICIENT Trial (NCT01032668) supports the use of high-dose clopidogrel for resistant patients.
Abstract

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