Residual platelet activity is increased in clopidogrel- and ASA-treated patients with coronary stenting for acute coronary syndromes compared with stable coronary artery disease

Geisler, T; Kapp, M; Göhring-Frischholz, K; Daub, K; Dösch, C; Bigalke, B; Langer, H; Herdeg, C; Gawaz, M
June 2008
Heart;Jun2008, Vol. 94 Issue 6, p743
Academic Journal
Objective: To evaluate residual platelet activity in a consecutive cohort of patients treated with dual antiplatelet therapy after coronary stent implantation Design: Prospective single-centre cohort study. Setting: University hospital in Germany. Patients: 480 patients with symptomatic coronary artery disease (n = 221 (46%) or acute coronary syndrome (ACS; n = 259 (54%) stable angina) were studied. Platelet activity was measured by collagen- (5 ~igIml) and adenosine diphosphate- (ADP; 20 jimol/l) induced platelet aggregation to assess post-treatment activity in patients treated with acetylsalicylic acid (500 mg bolus intra- venously followed by 100 mg once a day) and clopidogrel (600 nig loading dose followed by 75 mg once a day) Main outcome measures: Increased residual platelet activity (IRPA) was defined if platelet aggregation was in the upper tertile of values in the patient collective. Association of epidemiological factors with IRPA was evaluated in a multivariate logistic regression analysis. Results: IRPA-ADP was found in 53 patients (11.0%) and IRPA-collagen in 42 patients (8.8%). ACS was associated with IHPA independently from other factors (for IRPA- collagen: odds ratio (OR) = 2.3, 95% confidence interval (Cl) 1.2 to 4.5, p<0.05; for IRPA-ADP: OR = 2.4; 95% Cl 1.3 to 4.4, p<0.Ol; for IRPA-ADP/collagen: OR = 4.5, 95% Cl 1.2 to 16.9, p


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