Key result
Clopidogrel 150 mg/d for 30 days significantly decreased the rates of stent thrombosis and MACE compared to 75 mg/d without increasing bleeding in patients with CKD and clopidogrel resistance.
Why the study?
Does clopidogrel 150 mg/d reduce stent thrombosis and MACE compared to 75 mg/d in patients with CKD and clopidogrel resistance after PCI?
RCT (n=370)
Does clopidogrel 150 mg/d reduce stent thrombosis and MACE compared to 75 mg/d in patients with CKD and clopidogrel resistance after PCI?
A 150 mg/d maintenance dose of clopidogrel for 30 days safely reduces stent thrombosis and MACE in post-PCI patients with CKD and clopidogrel resistance.
Supports 150 mg/d clopidogrel for 30 days post-PCI in resistant CKD; extends tailored antiplatelet evidence in this high-risk subgroup.
We evaluated the impact of clopidogrel 150 mg/d in patients with chronic kidney disease (CKD) having clopidogrel resistance (CR) after percutaneous coronary intervention (PCI); 1076 consecutive patients with coronary artery disease (CAD) having CKD were enrolled. Maximal platelet aggregation (MPA) was assessed before, 24 hours, and 30 days after a 300-mg loading dose of clopidogrel prior to PCI. After PCI, 370 patients with CR were randomized to receive clopidogrel 75 mg/d (n = 184) or 150 mg/d (n = 186) for 30 days. Stent thrombosis (ST), major adverse cardiac events (MACEs), and bleeding were analyzed after 1 month. Patients in the 150 mg group had significant lower rates of ST and MACE. There was no significant difference in major or minor bleeding. Patients in the 150 mg group had lower MPA and greater inhibition of platelet aggregation. One-month administration of 150 mg/d of clopidogrel decreases the rate of ST and MACE without increasing bleeding in patients with CKD having CR after PCI.
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Liang et al. (2014) conducted an RCT in Chronic kidney disease with clopidogrel resistance after percutaneous coronary intervention (n=370). Clopidogrel vs. Clopidogrel 75 mg/d was evaluated on Stent thrombosis (ST), major adverse cardiac events (MACEs), and bleeding. Clopidogrel 150 mg/d for 30 days significantly decreased the rates of stent thrombosis and MACE compared to 75 mg/d without increasing bleeding in patients with CKD and clopidogrel resistance.
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