氯吡格雷与血小板反应.ppt

Introduction We have previously reported a significant incidence of clopidogrel resistance in patients post-elective coronary stenting treated with a standard 300-mg loading dose1 (31% at 24 hours) Patients with clopidogrel resistance/high post-stent platelet reactivity may be at greatest risk of SAT and ischemic events2-4 Relation of peri-procedural platelet reactivity to myocardial necrosis has never been prospectively studied These data suggest that 300 mg clopidogrel/75 mg qd does not provide sufficient inhibition in some patients undergoing elective coronary stenting Introduction (cont’d) Mechanisms of clopidogrel nonresponse/resistance are incompletely defined Introduction (cont’d) A large prospective pharmacodynamic study of clopidogrel 300 mg vs 600 mg is not available The effect of adding eptifibatide to these regimensis unknown ISAR REACT suggested no benefit of adding abciximab to patients loaded with 600 mg clopidogrel1 Patients all pretreated for ?2 hours (median 7.4 hours) Risk of bleeding with CABG in patients on clopidogrel therapy2 Low-risk group Objectives of CLEAR PLATELETS Trial Compare platelet reactivity following 4 treatments in low- to moderate-risk patients undergoing elective stenting Without pretreatment (CRUSADE) coronary anatomy unknown prior to procedure DOSING 600 mg Clopidogrel 600 mg Clopidogrel + eptifibatide 300 mg Clopidogrel 300 mg Clopidogrel + eptifibatide Analyze the relation of platelet reactivity to postprocedural myocardial necrosis Analyze the relation of platelet reactivity to postprocedural inflammation Methods Consecutive patients undergoing elective coronary stenting Exclusion criteria Chest pain 24 h AMI 48 h Chronic occlusion Illicit drug use PT 1.5 × Platelets 100,000/mm3 Creatinine 4.0 mg/dL Thienopyridine or GP IIb/IIIa use Methods (cont’d) Results: Demographics Results: Demographics (cont’d) Results: Angiographic Data Results: Clinical Outcomes (24 hours) Results: Platelet Reactivity Results: Plate