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Tailored Clopidogrel Dosing Improves PCI Outcomes
Date:3/29/2008

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.

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