View source for Platelet monitoring can improve outcomes following PCI among clopidogrel resistant patients

''March 29, 2008 By Lauren Ciaglo''

'''SCAI-ACCi2 08-Chicago, IL:''' Investigators from France demonstrate that platelet monitoring of [[clopidogrel]] response using VASP phosphorylation index decreases the rate of major adverse cardiovascular events in patients with [[clopidogrel]] resistance. 

This study was presented by Dr. Laurent Bonello at the SCAI-i2 summit Annual Scientific Sessions in Chicago today.  

[[Clopidogrel]] resistance is an important factor to take into account among patients undergoing [[percutaneous coronary intervention]] (PCI) particularly those who receive drug eluting [[stents]]. Previous studies demonstrated that a poor response to [[clopidogrel]] is associated with an increased risk of complications such as in-[[stent]] restenosis and [[stent]] [[thrombosis]].

The investigators from France studied patients with [[clopidogrel]] resistance (defined as more than 50% [[platelet]] activity after the standard 600mg loading dose). This study was a multicenter, randomized, prospective study. The outcome measures consisted of [[myocardial infarction]] (MI), needed repeat PCI or coronary artery bypass grafting surgery (CABG), or death

This study consisted of 162 patients who were [[clopidogrel]] resistant and in need of stenting for treatment of unstable [[angina]]. Patients were randomized to one of the two groups: control (n=84) or individually tailored therapy (n=78).  The individually tailored therapy consisted of increasing the [[clopidogrel]] dose in 600mg increments up to 2,400mg until [[platelet]] activity reduced to 50% or less.

The tailored therapy was effective 86% of patients and patients received 1,620 mg of [[clopidogrel]] prior to PCI.  The [[platelet]] activity reduced from 69.3% (after the first loading dose) to 37.6% with tailored therapy assessed by [[platelet]] monitoring. In the control group compared with the tailored therapy group the incidence of cardiovascular death was 2% vs. 0%, acute & subacute [[stent]] [[thrombosis]] was 5% vs. 0% (p=0.059), and revascularization was 2% vs. 0%.  There was a significant difference in the composite 30 day outcome between the control group and the tailored therapy group (10% vs. 0% p=0.007 respectively) with no difference in bleeding (5% vs. 4%).

This study demonstrates that tailoring the [[clopidogrel]] loading dose according to platelet activity can improve prognosis after [[PCI]]. In addition, it is evident from this study that on occasion, a loading dose of [[clopidogrel]] several times higher than usual is required in some patients to ensure its effectiveness.  Tailored therapy is associated with better cardiovascular outcome following [[PCI]].

==Source==
#Late Breaking Clinical Trials Session: SCAI Annual Scientific Sessions in partnership with ACC i2 summit, March 29-April 1, 2008 Chicago
#SCAI-ACC i2 press release
==Reference==
http://content.onlinejacc.org/cgi/content/abstract/j.jacc.2007.12.044v1
[[category:news]]
[[Category:Interventional Cardiology News]]

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