Clopidogrel tapering as a strategy to attenuate platelet rebound phenomenon in patients with bare-metal stents |
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Authors: | Idit Yedidya Adi Netzer Muthiah Vaduganathan Alejandro Solodky Ran Kornowski Eli I Lev |
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Institution: | (1) Department of Cardiology, Rabin Medical Center, Petah-Tikva, Tel-Aviv University, Tel-Aviv, Israel;(2) Northwestern University Feinberg School of Medicine, Chicago, IL, USA; |
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Abstract: | Early clustering of adverse cardiovascular events after abrupt cessation of clopidogrel has been reported in patients with
acute coronary syndromes. A platelet rebound phenomenon may contribute to this increased thrombotic risk and a gradual drug
tapering may attenuate this proposed platelet effect. Accordingly, we aimed to assess the effect of clopidogrel tapering on
platelet reactivity. Twenty patients who underwent elective percutaneous coronary interventions with bare metal stents receiving
3 months of clopidogrel therapy (75 mg daily) were randomized to either of two discontinuation strategies: (1) Off group–abrupt
drug cessation or (2) Tapering group–receiving clopidogrel 75 mg every other day for 4 weeks duration. Light transmission
aggregometry, induced by ADP (5 and 10 μM) and collagen, was measured at four time-points (at baseline and 2, 4 and 6 weeks
after randomization). In the off group, there was an early rise in platelet reactivity at 2 weeks after abrupt drug cessation
compared to baseline, as measured by ADP 5 μmol/l (39.6 ± 2.8 vs. 67.9 ± 6.0, P < 0.001). The tapering regimen suppressed this rebound platelet aggregation by ADP 5 μmol/l at 2 weeks (P = 0.001) and 4 weeks (P = 0.001). Similar results were found with ADP 10 μmol/l and collagen agonists. Abrupt cessation of clopidogrel results in
an early rise in platelet aggregability in patients with BMS that is attenuated by a tapering regimen. Clopidogrel administration
every other day may achieve similar levels of platelet inhibition as full dose therapy. Further investigations evaluating
clopidogrel tapering strategies and their potential clinical impact are warranted. |
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