Navigation Links
Tailored Clopidogrel Dosing Improves PCI Outcomes

Blood test monitors each patient's response to anti-clotting drug

CHICAGO, March 29 /PRNewswire/ -- Using a simple blood test to individualize the loading dose of a medication that prevents blood clotting significantly reduces the risk of major cardiovascular complications after percutaneous coronary interventions (PCI), according to a multicenter study reported today in a Late-Breaking Clinical Trials session at the SCAI Annual Scientific Sessions in Partnership with ACC i2 Summit (SCAI-ACCi2) in Chicago. SCAI-ACCi2 is a scientific meeting for practicing cardiovascular interventionalists sponsored by the Society for Cardiovascular Angiography and Interventions (SCAI) in partnership with the American College of Cardiology (ACC). The study will simultaneously publish in the Journal of the American College of Cardiology.

The study showed that in some patients, an initial, or loading, dose several times higher than usual is necessary to ensure the effectiveness of clopidogrel, a medication that prevents platelets from clumping together to form blood clots. The payoff for tailoring the clopidogrel dose: a significant reduction one month after PCI in the combined rates of heart attack, death, and need for repeat procedures to open the coronary arteries, with no increased risk of bleeding.

"Tailoring the loading dose of clopidogrel using platelet monitoring seems to be the best way to decrease the rate of major adverse cardiac events, in particular, stent thrombosis, which is the worst complication after PCI," said Laurent Bonello, MD, a cardiologist at Hopital Universitaire Nord, and Universite de la Mediterranee, both in Marseille, France.

Giving a large dose of clopidogrel before coronary stenting is standard procedure in cardiac catheterization laboratories. However, there is substantial variability among patients in the response to the anti-clotting drug. Previous studies have shown that a poor response to clopidogrel is linked to an increased risk of serious complications, including the growth of a blood clot inside the stent, or stent thrombosis.

To determine whether individualizing the clopidogrel dose could improve outcomes, Dr. Bonello and his colleagues enrolled 162 patients who were resistant to clopidogrel and needed stenting for treatment of unstable chest pain or a type of heart attack known as non-ST-elevation acute coronary syndrome. Clopidogrel resistance was defined as more than 50 percent platelet activity after a standard 600-mg clopidogrel loading dose. Patients were randomly assigned to a control group (84 patients) or to individually tailored therapy (78 patients), which consisted of increasing the clopidogrel dose in 600-mg increments up to a maximum of 2,400 mg until platelet activity dropped to 50 percent or less.

The dose adjustment was effective in 86 percent of patients. On average, patients in the tailored-therapy group received a total of 1,620 mg of clopidogrel before PCI, and experienced a drop in platelet activity from 69.3 after the first loading dose to 37.6 after extra dosing guided by platelet monitoring. After 30 days of follow-up, no patients in the tailored therapy group had suffered a heart attack, needed repeat PCI or bypass surgery, or died, whereas 10 percent of patients in the standard-dosing group had experienced one or more of these complications (p=0.007). The rates of bleeding were the same in both groups (5 percent vs. 4 percent).

"This is the first study demonstrating that adjusting the clopidogrel loading dose according to the patient's individual biological response can improve prognosis after percutaneous coronary revascularization," Dr. Bonello said.

Dr. Bonello will present the results of this study on Saturday, March 29 at 8:45 a.m. CDT in the Grand Ballroom, S100. This study will simultaneously publish in the Journal of the American College of Cardiology.

About SCAI

Headquartered in Washington, DC, the Society for Cardiovascular Angiography and Interventions is a 4,000-member professional organization representing invasive and interventional cardiologists in over 60 nations. SCAI's mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI's annual meeting has become the leading venue for education, discussion, and debate about the latest developments in this dynamic medical specialty.

About ACC

The American College of Cardiology is leading the way to optimal cardiovascular care and disease prevention. The College is a 34,000-member nonprofit medical society and bestows the credential Fellow of the American College of Cardiology upon physicians who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care.

Copyright©2008 PR Newswire.
All rights reserved

Related medicine technology :

1. Study Results Show Investigational Drug, Prasugrel, Cuts Risk of Stent-Related Clots by More than Half Versus Clopidogrel
2. Targanta Initiates Phase 2 Oritavancin Infrequent Dosing Study
3. New Phase III Data Presented for Once Monthly Dosing Regimen of Risedronate to Treat Postmenopausal Osteoporosis
4. DiObex Begins Dosing Patients in Phase 2b Trial of Type 2 Diabetes Drug
5. Pharmasset Commences Dosing in Phase 3 Registration Studies of Clevudine for HBV
6. Pharmasset Commences Dosing in 28-Day Combination Study of R7128 with Pegasys(R) plus Copegus(R) for Hepatitis C
7. Anthera Announces Completion of Enrollment and Dosing in Phase II Trial of A-002 for the Treatment of Cardiovascular Disease
8. Rockwell Medical Technologies, Inc. Begins Dosing Patients for SFP Phase IIb Clinical Study
9. Pivotal MIRCERA(R) Study First to Convert Dialysis Patients From Frequent Dosing Directly to Once Every Two Weeks or Once Every Four Weeks
10. Potent Hepatitis C Virus Inhibitors Show Efficacy and Potential for Once Daily Dosing in Preclinical Studies
11. Genta Completes Initial Clinical Dosing of G4544, a New Oral Drug for Bone Diseases
Post Your Comments:
(Date:11/24/2015)... DELHI , November 25, 2015 ... invoked due to repeated failure of IVF cycles. After ... Bhatia was totally dejected and had lost all hopes that she would be ... first Indian miracle child conceived after failure of over ... to abroad (UK) before they decided to take one last attempt ...
(Date:11/24/2015)...  In the pharmaceutical industry, companies want to rapidly ... uncover new insights, tactics and strategies that will improve ... --> However, organizations often find it is difficult ... that all rules and regulations are met to ensure ... to efficiently launching market research projects is the conflicting ...
(Date:11/24/2015)... , November 24, 2015 --> ... report "Spine Biologics Market by Product Type (Bone Graft, Bine ... Discectomy and Fusion, Posterior Lumbar Interbody Fusion), End User, and ... global market was valued at $1.90 Billion in 2014 and ... CAGR of 4.4% during the forecast period of 2015 to ...
Breaking Medicine Technology:
(Date:11/24/2015)... ... ... Serenity Point Rehabilitation, a holistic treatment center for substance abuse located in ... staff members at their recovery center. The videos highlight some of the various aspects ... things that make their recovery program so unique. , “Making the decision to seek ...
(Date:11/24/2015)... ... November 24, 2015 , ... Cold Shoulder , LLC launched their Pro Vest, the latest ... hit their goal of $20,000 in under 10 hours. , The campaign, ... PRO Weight Loss Vest to the market. , The PRO Vest provides consumers with a ...
(Date:11/24/2015)... ... ... Dr. Rodney E. Willey , has answered a new calling – to relieve snoring ... treatment for snoring and sleep apnea through oral appliance therapy. He is ... in the US, one of four in the Illinois area. , Dr. Willey’s ...
(Date:11/24/2015)... ... ... Bibliomotion is thrilled to announce the launch of UNCONVENTIONAL ... Nancy M. Schlichting, Chief Executive Officer of Henry Ford Health System (November ... of patients and their families, shaped my desire to improve the system of care. ...
(Date:11/24/2015)... ... November 24, 2015 , ... ... products, announces Innovative Blending, a household invention that revolutionizes the vending machine industry ... Smoothie Bars market is worth $2 billion," says Scott Cooper, CEO and Creative ...
Breaking Medicine News(10 mins):