What is the clinical evidence from this study?

Study design: Cohort. Population: Elective coronary stenting (n=94). Intervention: Standard aspirin and clopidogrel regimen vs. Baseline. Primary outcome: Heightened platelet reactivity (by ADP aggregation) and activation (by active GP IIb/IIIa expression) above baseline.

What question did this study set out to answer?

To evaluate platelet reactivity and activation over 30 days in patients undergoing elective coronary stenting who receive standard clopidogrel and aspirin therapy.

January 1, 2004Platelets

Failure of clopidogrel to reduce platelet reactivity and activation following standard dosing in elective stenting: implications for thrombotic events and restenosis

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Key result

Following elective stenting, standard clopidogrel and aspirin therapy left 15% of patients with heightened platelet reactivity and 22% with heightened activation at 30 days compared to baseline.

Why the study?

Does standard aspirin and clopidogrel therapy sufficiently reduce platelet reactivity and activation following elective coronary stenting?

Population

94 patients undergoing elective coronary stenting

Comparison

Standard aspirin and clopidogrel regimen vs Baseline levels (pre-stenting)

Design

Cohort

Follow-up

30 days

Authors

PGPaul A. GurbelInterventional Cardiology WSWaiel M. SamaraSinai Hospital KBKevin P. BlidenInterventional Cardiology

Discussion

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Implication

Persistent platelet hyperactivity on standard DAPT after elective stenting warrants caution; leaves open whether tailored regimens improve outcomes in trials.

Key Points

To evaluate platelet reactivity and activation over 30 days in patients undergoing elective coronary stenting who receive standard clopidogrel and aspirin therapy.
Evaluated 94 patients undergoing elective coronary stenting receiving standard aspirin (325 mg) and clopidogrel (300 mg load, 75 mg daily).
Measured platelet aggregation using 5 and 20 μM ADP and assessed total and active glycoprotein IIb/IIIa receptor expression at baseline, 2 hours, 24 hours, 5 days, and 30 days post-stenting.
Heightened platelet reactivity (20 μM ADP aggregation above baseline) occurred in 55% of patients at 2 hours, 26% at 24 hours, 21% at 5 days, and 15% at 30 days post-procedure.
Heightened platelet activation (active GP IIb/IIIa expression above baseline) was present in 27% of patients at 2 hours, 20% at 24 hours, 30% at 5 days, and 22% at 30 days post-procedure.

Study Design

Type

Cohort (n=94)

Structured PICO

Does standard aspirin and clopidogrel therapy sufficiently reduce platelet reactivity and activation following elective coronary stenting?

Population

94 patients undergoing elective coronary stenting treated with standard aspirin and clopidogrel, followed for 30 days to assess platelet reactivity and activation.

Exposure

Standard aspirin (325 mg) and clopidogrel regimen (300 mg load/75 mg qd)

Comparator

Baseline levels (pre-stenting)

Outcome

Platelet reactivity (aggregation by 5 and 20 microM ADP) and activation (expression of total and active GP IIb/IIIa) at 2 h, 24 h, 5 days, and 30 days post-stentingsurrogate

A significant proportion of patients undergoing elective stenting on standard aspirin and clopidogrel therapy exhibit persistent heightened platelet reactivity and activation up to 30 days post-procedure, suggesting inadequate platelet inhibition.

Cite This Study

Gurbel et al. (2004) conducted a cohort in Elective coronary stenting (n=94). Standard aspirin and clopidogrel regimen vs. Baseline was evaluated on Heightened platelet reactivity (by ADP aggregation) and activation (by active GP IIb/IIIa expression) above baseline. Following elective stenting, standard clopidogrel and aspirin therapy left 15% of patients with heightened platelet reactivity and 22% with heightened activation at 30 days compared to baseline.

synapsesocial.com/papers/6a9af0522a75e43d92f482c8 https://doi.org/10.1080/09537100310001646950

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Implication

Persistent platelet hyperactivity on standard DAPT after elective stenting warrants caution; leaves open whether tailored regimens improve outcomes in trials.

Failure of clopidogrel to reduce platelet reactivity and activation following standard dosing in elective stenting: implications for thrombotic events and restenosis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Failure of clopidogrel to reduce platelet reactivity and activation following standard dosing in elective stenting: implications for thrombotic events and restenosis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

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