Journal Article

High clopidogrel loading dose during coronary stenting: effects on drug response and interindividual variability

Dominick J. Angiolillo, Antonio Fernández-Ortiz, Esther Bernardo, Celia Ramírez, Manel Sabaté, Camino Bañuelos, Rosana Hernández-Antolín, Javier Escaned, Raul Moreno, Fernando Alfonso and Carlos Macaya

in European Heart Journal

Published on behalf of European Society of Cardiology

Volume 25, issue 21, pages 1903-1910
Published in print November 2004 | ISSN: 0195-668x
Published online November 2004 | e-ISSN: 1522-9645 | DOI: http://dx.doi.org/10.1016/j.ehj.2004.07.036
High clopidogrel loading dose during coronary stenting: effects on drug response and interindividual variability

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Aim

To assess platelet inhibitory effects, interindividual variability in platelet inhibition as well as response to a 600 mg, compared to a standard 300 mg, clopidogrel loading dose (LD) after coronary stenting

Methods and results

Platelet function profiles were assessed in 50 patients undergoing coronary stenting receiving either a 300 mg (n=27) or 600 mg clopidogrel LD. ADP (6 μM) and collagen (6 μg/mL) induced platelet aggregation, as well as ADP (2 μM) induced glycoprotein (GP) IIb/IIIa activation and P-selectin expression were assessed at baseline and 4, 24, and 48 h following clopidogrel front-loading. A more intense and rapid inhibition of platelet activation (both GP IIb/IIIa activation and P-selectin expression) were achieved using a 600 mg, compared to a 300 mg, LD throughout the entire 48 hours (p<0.001). Although there were no differences in platelet aggregation, overall a 600 mg LD increased the number of clopidogrel responders and this was also achieved earlier compared to a 300 mg LD. A 600 mg LD did not reduce interindividual variability of platelet response.

Conclusion

The use of a 600 mg clopidogrel LD in patients undergoing coronary stenting optimises platelet inhibitory effects early after intervention and may provide a more effective protection against early thrombotic complications.

Journal Article.  4503 words.  Illustrated.

Subjects: Cardiovascular Medicine

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