August 1, 1996Circulation
Platelet Activation and Coronary Stent Implantation
Why the study?
Does combined antiplatelet therapy with ticlopidine and aspirin reduce platelet activation compared to conventional anticoagulation therapy in low-risk patients after coronary stent implantation?
Population
76 matched 'low-risk' patients who underwent coronary Palmaz-Schatz stent implantation. Matched for…
Comparison
Ticlopidine and aspirin after stenting vs Conventional anticoagulation therapy, including…
Design
Case-control
Follow-up
12 days
Authors
Discussion
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Implication
Ticlopidine-aspirin was associated with reduced platelet activation versus anticoagulation after stenting; leaves open impact on thrombosis with modern regimens.
Key Points
- To evaluate and compare the impact of dual antiplatelet therapy versus conventional anticoagulation on post-procedural platelet activation in patients receiving coronary Palmaz-Schatz stents.
- Evaluated 38 matched pairs from a dual antiplatelet study cohort (ticlopidine 250 mg BID plus aspirin 100 mg BID, n=46) and a conventional anticoagulation cohort (phenprocoumon, heparin, and aspirin, n=151).
- Measured surface expression of platelet activation markers (LIBS1 and CD62P/P-selectin) and platelet counts before stenting and daily for 12 days post-procedure.
- Patients on conventional anticoagulation experienced significant increases in LIBS1 (P < .05) and CD62P (P < .001) above prestent values peaking on days 3 to 6, alongside a significant platelet count decline on day 3 (P < .01).
- Patients receiving ticlopidine plus aspirin showed a significant decrease in LIBS1 expression (P < .01), stable CD62P expression, and no significant change in platelet counts.
Structured PICO
Does combined antiplatelet therapy with ticlopidine and aspirin reduce platelet activation compared to conventional anticoagulation therapy in low-risk patients after coronary stent implantation?
P
Population
76 matched 'low-risk' patients (38 per group) who underwent coronary Palmaz-Schatz stent implantation. Matched for indication for stenting, target vessel, balloon size, inflation pressure, and number of inserted stents.
I
Intervention
Ticlopidine (250 mg BID) and aspirin (100 mg BID) after stenting
C
Comparator
Conventional anticoagulation therapy, including phenprocoumon (target INR 3.5), heparin (aPTT 80 to 120 seconds), and aspirin (100 mg BID) after stenting
O
Outcome
Platelet function evaluated by immunologic activation markers (surface exposure of LIBS1 and CD62P) and platelet count before and daily for 12 days after stentingsurrogate
Combined antiplatelet therapy with ticlopidine and aspirin deactivates platelets compared to conventional anticoagulation, providing a mechanistic basis for reduced subacute stent thrombosis after coronary stenting.
Cite This Study
Gawaz et al. (1996) studied this question.