What question did this study set out to answer?

January 1, 2015

Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting: a single center, randomized, feasibility study.

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Why the study?

Does tailored antiplatelet therapy based on clopidogrel responsiveness reduce cardiovascular death, myocardial infarction, or stroke in clopidogrel-naïve patients with ACS undergoing coronary stenting?

Key Points

To assess the feasibility, efficacy, and safety of tailoring antiplatelet therapy based on clopidogrel responsiveness in patients with acute coronary syndrome undergoing coronary stenting.
Conducted a single-center, randomized feasibility study enrolling 305 clopidogrel-naïve patients with acute coronary syndromes undergoing coronary stenting.
Randomly assigned participants to standard dual antiplatelet therapy with aspirin and clopidogrel (n = 151) or tailored therapy (n = 154).
In the tailored group, light transmission aggregometry identified low clopidogrel responsiveness; non-responsive patients received standard therapy plus 6 months of adjunctive cilostazol.
Low clopidogrel responsiveness occurred in 26.6% (41/154) of tailored patients, whose platelet aggregation significantly dropped after 3 days of adjunctive cilostazol (77.5% ± 12.1% vs. 64.5% ± 12.1%, P < 0.001).
The primary composite outcome of cardiovascular death, myocardial infarction, or stroke at one year occurred in 5.8% of tailored patients versus 9.3% of standard patients (relative risk reduction 37%, P = 0.257).
Stent thrombosis and hemorrhagic event rates showed no significant differences between the two groups.

Structured PICO

Population

305 clopidogrel naïve patients with acute coronary syndromes (ACS) undergoing coronary stenting

Intervention

Tailored antiplatelet therapy (standard dual antiplatelet therapy with aspirin and clopidogrel for non-low responsiveness patients, and an additional 6-month cilostazol treatment for low responsiveness patients)

Comparator

Standard antiplatelet therapy (dual antiplatelet therapy with aspirin and clopidogrel)

Outcome

Composite of cardiovascular death, myocardial infarction or stroke at one yearcomposite

Tailored antiplatelet therapy with adjunctive cilostazol for clopidogrel low-responders is feasible but did not significantly reduce ischemic events in this small trial.

Limitations

small sample size

Discussion

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Implication

Tailored antiplatelet therapy showed no significant benefit; leaves open efficacy of platelet function-guided adjustment in ACS stenting.

Cite This Study

Zhu et al. (2015) studied this question.

synapsesocial.com/papers/6a71893c2163a0a01bc5a1e7 https://doi.org/10.11909/j.issn.1671-5411.2015.01.003

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Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting: a single center, randomized, feasibility study.

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting: a single center, randomized, feasibility study.

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider