The clopidogrel resistance can be attenuated with triple antiplatelet therapy in patients undergoing drug-eluting stents implantation.
BACKGROUND
Triple antiplatelet therapy may have a beneficial effect on prevention of thrombotic complication in patients undergoing coronary stenting. We investigated the prevalence of aspirin and clopidogrel resistance in patients treated with dual and triple antiplatelet regimen after percutaneous coronary intervention (PCI) with drug-eluting stents (DES).


METHODS
A total of 400 consecutive patients underwent successful PCI with DES were randomly assigned to therapy with dual antiplatelet regimens (aspirin plus clopidogrel, Group I, n = 200) and triple antiplatelet regimens (aspirin plus clopidogrel plus cilostazol, Group II, n = 200) At two weeks after PCI, aspirin and clopidogrel resistance were assayed in 379 patients (Group I, n = 186; Group II, n = 193) by using the VerifyNow System.


RESULTS
In Group I, 21 (11.3%) patients had aspirin resistance and 74 (40.0%) had clopidogrel resistance. In Group II, 19 (9.8%) were resistant to aspirin and 38 (19.7%) to clopidogrel. The aspirin reaction unit (ARU) was not significantly different between groups (448+/-67 vs. 439+/-64, P = 0.200), but the percent inhibition of clopidogrel was higher in Group II (41.4+/-24.3%,) comparing with that of Group I (26.5+/-18.7%, P < 0.001).


CONCLUSIONS
With triple antiplatelet therapy, the prevalence of clopidogrel resistance can be attenuated in patients undergoing PCI with DES.
Shim
Chi Young
CY
Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Yoon
Se-Jung
SJ
Park
Sungha
S
Kim
Jung-Sun
JS
Choi
Jong Rak
JR
Ko
Young-Guk
YG
Choi
Donghoon
D
Ha
Jong-Won
JW
Jang
Yangsoo
Y
Chung
Namsik
N
Shim
Won-Heum
WH
Cho
Seung-Yun
SY
D000368:Aged; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D000077144:Clopidogrel; D004351:Drug Resistance / Q000187:drug effects / Q000502:physiology*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine