The Relation of Dosing to Clopidogrel Responsiveness and the Incidence of High Post-Treatment Platelet Aggregation in Patients Undergoing Coronary Stenting
- 1 May 2005
- journal article
- clinical trial
- Published by Elsevier BV in Journal of the American College of Cardiology
- Vol. 45 (9), 1392-1396
- https://doi.org/10.1016/j.jacc.2005.01.030
Abstract
We determined the effect of clopidogrel dosing on the incidence of nonresponsiveness (NR) and high post-treatment platelet aggregation (post-PA). We have reported NR after a 300-mg loading dose. Limited information is available on the comparative effect of a 600-mg loading dose on the incidence of NR and high post-PA. Clopidogrel responsiveness and post-PA were measured in patients undergoing stenting (n = 190) randomly treated with either a 300-mg or a 600-mg clopidogrel load. Nonresponsiveness was defined as 75th percentile aggregation after 300 mg clopidogrel. Nonresponsiveness was lower after 600 mg compared to the 300-mg dose (8% vs. 28% and 8% vs. 32% with 5 and 20 μM ADP, respectively, p < 0.001). Among the patients with high post-PA after 300 mg clopidogrel, 62% to 65% had NR, whereas after the 600-mg dose, all of the patients with high post-PA had NR. A 600-mg clopidogrel loading dose reduces the incidence of NR and high post-PA as compared to a 300-mg dose. Higher dosing strategies and methods to confirm platelet inhibition should be further investigated in order to optimally use clopidogrel in patients undergoing stenting.Keywords
This publication has 15 references indexed in Scilit:
- High clopidogrel loading dose during coronary stenting: effects on drug response and interindividual variabilityEuropean Heart Journal, 2004
- Loading With 600 mg Clopidogrel in Patients With Coronary Artery Disease With and Without Chronic Clopidogrel TherapyCirculation, 2004
- Clopidogrel Resistance Is Associated With Increased Risk of Recurrent Atherothrombotic Events in Patients With Acute Myocardial InfarctionCirculation, 2004
- Contribution of Hepatic Cytochrome P450 3A4 Metabolic Activity to the Phenomenon of Clopidogrel ResistanceCirculation, 2004
- Failure of clopidogrel to reduce platelet reactivity and activation following standard dosing in elective stenting: implications for thrombotic events and restenosisPlatelets, 2004
- Pharmacokinetics of clopidogrel after administration of a high loading doseThrombosis and Haemostasis, 2004
- Short CommunicationA new method of representing drug-induced platelet inhibition: better description of time course, response variability, non-response, and heightened reactivityPlatelets, 2003
- Resistance to thienopyridines: Clinical detection of coronary stent thrombosis by monitoring of vasodilator‐stimulated phosphoprotein phosphorylationCatheterization and Cardiovascular Interventions, 2003
- Clopidogrel for Coronary StentingCirculation, 2003
- Effect of a high loading dose of clopidogrel on platelet function in patients undergoing coronary stent placementHeart, 2001