Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting： a single center, randomized, feasibility study  

作　　者：Hong-Chang ZHU Yi LI Shao-Yi GUAN Jing LI Xiao-Zeng WANG Quan-Min JING Zu-Lu WANG Ya-Ling HAN 

机构地区：[1]Second Affiliated Hospital of Dalian Medical University, Dalianl 16023, Shandong Province, China [2]Cardiovascular Institute, General Hospital of Shenyang Military Region, Shenyang 110016, Liaoning Province, China

出　　处：《Journal of Geriatric Cardiology》2015年第1期23-29,共7页老年心脏病学杂志（英文版）

摘　　要：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 naive 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.

关 键 词：Acute coronary syndrome Antiplatelet therapy CLOPIDOGREL Coronary stenting 

分 类 号：Q51[生物学—生物化学] T-1[一般工业技术]