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Thromb Haemost 2008; 99(01): 161-168
DOI: 10.1160/TH07-09-0562
Cardiovascular Biology and Cell Signalling
Schattauer GmbH

Functional impact of high clopidogrel maintenance dosing in patients undergoing elective percutaneous coronary interventions

Results of a randomized study
Dominick J Angiolillo
1   Division of Cardiology, University of Florida College of Medicine-Shands Jacksonville, Jacksonville, Florida, USA
,
Esther Bernardo
2   Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain
,
Jorge Palazuelos
2   Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain
,
Bhaloo Desai
1   Division of Cardiology, University of Florida College of Medicine-Shands Jacksonville, Jacksonville, Florida, USA
,
Ian Weisberg
1   Division of Cardiology, University of Florida College of Medicine-Shands Jacksonville, Jacksonville, Florida, USA
,
Fernando Alfonso
2   Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain
,
Luis A Guzman
1   Division of Cardiology, University of Florida College of Medicine-Shands Jacksonville, Jacksonville, Florida, USA
,
Rosana Hernández-Antolin
2   Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain
,
Martin Z Zenni
1   Division of Cardiology, University of Florida College of Medicine-Shands Jacksonville, Jacksonville, Florida, USA
,
Carlos Macaya
2   Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain
,
Antonio Fernandez-Ortiz
2   Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain
,
Theodore A Bass
1   Division of Cardiology, University of Florida College of Medicine-Shands Jacksonville, Jacksonville, Florida, USA
› Author AffiliationsFinancial support: This study was funded by a grant from the Fundación Médica para la inviestigación de la Mutua Madrileña, and from the University of Florida College of Medicine-Jacksonville, USA.
Further Information

Publication History

Received: 15 September 2007

Accepted after major revision: 25 October 2007

Publication Date:
24 November 2017 (online)

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Summary

The currently recommended maintenance dose of clopidogrel is often associated with inadequate platelet inhibition, suggesting the need for a higher dose. The aim of this pilot study was to assess the functional impact of a high (150 mg/day) maintenance dose of clopidogrel in patients undergoing elective percutaneous coronary intervention (PCI).This is a prospective, randomized, platelet function study which was performed in elective PCI patients assigned to treatment with either a 75 mg (n=20) or 150 mg (n=20) daily maintenance dose of clopidogrel for 30 days;afterwards, all patients resumed standard dosing. Platelet aggregation was performed using light transmittance aggregometry following 20 μM and 5 μM adenosine diphosphate (ADP) stimuli 30 days after randomization and 30 days after resuming standard dosing. Patients treated with 150 mg/day clopidogrel had lower 20 μMADP-induced platelet aggregation compared to patients on 75 mg/day (52.1±9% vs. 64.0±8%; p<0.001; primary endpoint).The dose-dependent effect was confirmed by the absolute and relative increase in platelet aggregation after resuming standard dosing (p<0.001). No changes were observed in patients randomized to standard dosing. Parallel findings were observed following 5 μM ADP stimuli for all assessments. A broad variability in clopidogrel-induced antiplatelet effects was observed irrespective of dosing. In conclusion, a 150 mg/day maintenance dose regimen of clopidogrel is associated with reduced platelet reactivity and enhanced platelet inhibition compared to that achieved with the currently recommended 75 mg/day in patients undergoing elective PCI.

Keywords

Clopidogrel - platelet - coronary stenting
 

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