Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the...

Area of Science:

• Cardiology
• Pharmacology
• Interventional Cardiology

Background:

• High platelet reactivity is a risk factor for cardiovascular events post-percutaneous coronary intervention (PCI).
• Optimal treatment strategies for managing high on-treatment reactivity remain undefined.

Purpose of the Study:

• To compare the efficacy of high-dose versus standard-dose clopidogrel.
• To evaluate outcomes in patients with high on-treatment reactivity following PCI.

Main Methods:

• The Gauging Responsiveness with A VerifyNow assay-Impact on Thrombosis And Safety (GRAVITAS) trial randomized 2214 patients.
• Patients received either high-dose (600mg loading, 150mg daily) or standard-dose (75mg daily) clopidogrel for 6 months.
• Primary endpoint: 6-month incidence of cardiovascular death, myocardial infarction, or stent thrombosis.

Main Results:

• No significant difference in the primary endpoint between high-dose and standard-dose clopidogrel groups (2.3% vs 2.3%; HR, 1.01; P = .97).
• Severe or moderate bleeding rates were similar between groups (1.4% vs 2.3%; HR, 0.59; P = .10).
• High-dose clopidogrel significantly reduced high on-treatment reactivity at 30 days (40% vs 62%; P < .001).

Conclusions:

• High-dose clopidogrel did not improve clinical outcomes for patients with high on-treatment reactivity post-PCI.
• Standard-dose clopidogrel is appropriate for patients with high on-treatment reactivity after PCI with drug-eluting stents.