Adjunctive Cilostazol versus High Maintenance Dose of Clopidogrel in Patients with Hyporesponsiveness to Chronic Clopidogrel Therapy.
- Author:
Ga Yeon LEE
1
;
Joo Yong HAHN
;
Soo Youn LEE
;
Hee Jin KIM
;
Jun Hyung KIM
;
Sang Yup LEE
;
Young Bin SONG
;
Seung Hyuk CHOI
;
Jin Ho CHOI
;
Hyeon Cheol GWON
Author Information
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords: Clopidogrel; cilostazol; platelets
- MeSH: Adult; Aged; Blood Platelets/drug effects; Cross-Over Studies; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors/*administration & dosage; Prospective Studies; Receptors, Purinergic P2Y12/metabolism; Tetrazoles/*administration & dosage; Thrombosis/drug therapy; Ticlopidine/administration & dosage/*analogs & derivatives; Time Factors; Treatment Outcome
- From:Yonsei Medical Journal 2013;54(1):34-40
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: Whether addition of cilostazol is superior to increasing dose of clopidogrel in patients with hyporesponsiveness to chronic clopidogrel therapy is unknown. MATERIALS AND METHODS: We studied 73 patients with hyporesponsiveness to clopidogrel on standard dual antiplatelet therapy for more than 2 weeks. Clopidogrel hyporesponsiveness was defined as percent inhibition of P2Y12 reaction units (PRU) <30% on VerifyNow P2Y12 assay. Patients were randomly assigned to increased dose of clopidogrel (aspirin 100 mg+clopidogrel 150 mg daily: group A, n=38) or to receiving additional cilostazol (aspirin 100 mg+clopidogrel 75 mg+cilostazol 100 mg bid daily: group B, n=35). RESULTS: Baseline percent inhibition of PRU and PRU was similar between 2 groups (13.0+/-10.2% versus 11.8+/-9.7%, p=0.61, and 286.3+/-54.7 versus 295.7+/-53.7, p=0.44, respectively). At follow-up, percent inhibition of PRU was higher and PRU was lower significantly in group B than in group A (38.5+/-17.9% versus 28.3+/-16.6%, p=0.02, and 207.3+/-68.2 versus 241.3+/-76.7, p=0.050, respectively). Among those still showing hyporesponsiveness to clopidogrel at follow-up (21 patients in group A, 10 patients in group B), 12 patients completed further crossover study. Compared to the baseline, magnitude of change in percent inhibition of PRU and PRU showed an improved tendency after the crossover (from 2.7+/-8.7% to 15.8+/-18.4%, p=0.08, and from -18.6+/-58.0 to -61.9+/-84.3, p=0.08). CONCLUSION: Adjunctive cilostazol improved clopidogrel responsiveness better than the higher maintenance dose of clopidogrel in hyporesponsive patients with chronic clopidogrel therapy.
