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Dominick J. Angiolillo, Antonio Fernández-Ortiz, Esther Bernardo, Celia Ramírez, Manel Sabaté, Camino Bañuelos, Rosana Hernández-Antolín, Javier Escaned, Raul Moreno, Fernando Alfonso, Carlos Macaya, High clopidogrel loading dose during coronary stenting: effects on drug response and interindividual variability, European Heart Journal, Volume 25, Issue 21, November 2004, Pages 1903–1910, https://doi.org/10.1016/j.ehj.2004.07.036
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Abstract
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
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.
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.
