Department of Radiology, Interventional Neuroradiology, Virgen del Rocio University Hospital, Seville, Spain.
Department of Neurology, Virgen del Rocio University Hospital, Seville, Spain.
J Vasc Surg. 2014 Aug;60(2):428-35. doi: 10.1016/j.jvs.2014.01.068. Epub 2014 Mar 11.
Clopidogrel plays a central role in the treatment of patients undergoing carotid artery stenting (CAS). The objective was to evaluate the effect of clopidogrel (75 mg/d) on platelet reactivity in responders and nonresponders and the antiplatelet effect of different doses of clopidogrel in patients with high on-treatment reactivity (OTR) after CAS.
Patients with high OTR (defined by VerifyNow (Accumetrics, San Diego, Calif) assay as ≥230 P2Y12 reaction units [PRU]) were randomly assigned in a 1:1 ratio to group 1 (standard-dose clopidogrel therapy: 75 mg/d for 30 days) or group 2 (high-dose clopidogrel: 150 mg/d for 30 days).
The study enrolled 214 patients. Of these, 115 (53.7%) were clopidogrel responders (group 0), and 99 (46.3%) had high OTR (clopidogrel nonresponders); of which, 50 were randomly assigned to group 1 and 49 to group 2. At baseline, the PRU value did not differ between group 1 (288.50 ± 46) and group 2 (295.45 ± 47.2; P = .308). Patients displayed reduced mean platelet reactivity levels at 30 days in group 1 (238.96 ± 72.25; P < .001) and group 2 (201.85 ± 77.8; P < .001). Although high-dose clopidogrel resulted in more intense platelet function inhibition, the differences between median 30-day PRU values (P = .483) and the percentage change of PRU (P = .442) for groups 1 and 2 were not significant. The incidences of transient ischemic attack, stroke, or death at up to 30 days after CAS in the high-OTR patients were similar between groups 1 and 2 (P = .481).
Patients with high OTR undergoing CAS treated with standard-dose and double-dose clopidogrel had significantly reduced platelet reactivity after 30 days. The double dose did not result in statistically significantly greater reductions in reactivity compared with the standard dose.
氯吡格雷在颈动脉支架置入术（CAS）患者的治疗中发挥核心作用。本研究旨在评估氯吡格雷（75mg/d）对反应者和无反应者血小板反应性的影响，以及氯吡格雷在 CAS 后高治疗反应性（OTR）患者中的不同剂量的抗血小板作用。
高 OTR 患者（通过 VerifyNow（Accumetrics，圣地亚哥，加利福尼亚州）测定定义为≥230 P2Y12 反应单位[PRU]）被随机按 1:1 比例分配至组 1（标准剂量氯吡格雷治疗：30 天内 75mg/d）或组 2（高剂量氯吡格雷：30 天内 150mg/d）。
本研究共纳入 214 例患者。其中，115 例（53.7%）为氯吡格雷反应者（组 0），99 例（46.3%）为高 OTR（氯吡格雷无反应者）；其中，50 例被随机分配至组 1，49 例至组 2。基线时，组 1（288.50±46）与组 2（295.45±47.2；P=.308）的 PRU 值无差异。组 1（238.96±72.25；P<.001）和组 2（201.85±77.8；P<.001）的患者在 30 天时的平均血小板反应性水平均降低。尽管高剂量氯吡格雷导致血小板功能抑制更强烈，但两组 30 天 PRU 值中位数（P=.483）和 PRU 变化百分比（P=.442）的差异无统计学意义。高 OTR 患者在 CAS 后 30 天内的短暂性脑缺血发作、卒中和死亡发生率在组 1 和组 2 之间相似（P=.481）。
行 CAS 的高 OTR 患者接受标准剂量和双倍剂量氯吡格雷治疗后，30 天后血小板反应性显著降低。与标准剂量相比，双倍剂量并未导致反应性的统计学显著降低。
