title: Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting: a single center, randomized, feasibility study.
abstract: BACKGROUND
  Low responsiveness to clopidogrel (LRC) is associated with increased risk of ischemic events. This study was aimed to explore the feasibility of tailored antiplatelet therapy according to the responsiveness to clopidogrel.
  
  
  METHODS
  A total of 305 clopidogrel naïve patients with acute coronary syndromes (ACS) undergoing coronary stenting were randomly assigned to receive standard (n = 151) or tailored (n = 154) antiplatelet therapy. The ADP-induced platelet aggregation tests by light transmission aggregometry were performed to identify LRC patients assigned to the tailored group. The standard antiplatelet regimen was dual antiplatelet therapy with aspirin and clopidogrel. The tailored antiplatelet therapy was standard regimen for non-LRC patients and an additional 6-month cilostazol treatment for LRC patients. The primary efficacy outcome was the composite of cardiovascular death, myocardial infarction or stroke at one year.
  
  
  RESULTS
  LCR was present in 26.6% (41/154) of patients in the tailored group. The percentage platelet aggregation for LCR patients was significantly decreased at three days after adjunctive cilostazol treatment (77.5% ± 12.1% vs. 64.5% ± 12.1%, P < 0.001). At one year follow-up, a non-significant 37% relative risk reduction of primary events were observed in the tailored group as compared to the standard group (5.8% vs. 9.3%, P = 0.257). There were no differences in the rates of stent thrombosis and hemorrhagic events between the two groups.
  
  
  CONCLUSIONS
  Tailored antiplatelet therapy for ACS patients after coronary stenting according to responsiveness to clopidogrel is feasible. However, its efficacy and safety need further confirmation by clinical trials with larger sample sizes.
authors: Second Affiliated Hospital of Dalian Medical University, Dalian116023, Shandong Province, China ; Cardiovascular Institute, General Hospital of Shenyang Military Region, Shenyang 110016, Liaoning Province, China.
authors: Hong-Chang
authors: HC
authors: Zhu
authors: Cardiovascular Institute, General Hospital of Shenyang Military Region, Shenyang 110016, Liaoning Province, China.
authors: Yi
authors: Y
authors: Li
authors: Cardiovascular Institute, General Hospital of Shenyang Military Region, Shenyang 110016, Liaoning Province, China.
authors: Shao-Yi
authors: SY
authors: Guan
authors: Cardiovascular Institute, General Hospital of Shenyang Military Region, Shenyang 110016, Liaoning Province, China.
authors: Jing
authors: J
authors: Li
authors: Cardiovascular Institute, General Hospital of Shenyang Military Region, Shenyang 110016, Liaoning Province, China.
authors: Xiao-Zeng
authors: XZ
authors: Wang
authors: Cardiovascular Institute, General Hospital of Shenyang Military Region, Shenyang 110016, Liaoning Province, China.
authors: Quan-Min
authors: QM
authors: Jing
authors: Cardiovascular Institute, General Hospital of Shenyang Military Region, Shenyang 110016, Liaoning Province, China.
authors: Zu-Lu
authors: ZL
authors: Wang
authors: Cardiovascular Institute, General Hospital of Shenyang Military Region, Shenyang 110016, Liaoning Province, China.
authors: Ya-Ling
authors: YL
authors: Han
keywords: Acute coronary syndrome; Antiplatelet therapy; Clopidogrel; Coronary stenting