Study On The Antiplatelet Effects, Clinical Efficacy And Safety Of Clopidogrel On CAD Patients Undergoing Stent Implantation

Part I The occurrence of clopidogrel low response inpatients with stent thrombosis and the treatment stratergyObjectives: To investigate the occurrence of clopidogrel low response in patientswith stent thrombosis and evaluate the efficacy of double dose clopidogrel.Methods:9patients with coronary angiography diagnosed stent thrombosis wereincluded as the study group, and another100hospitalized patients who received stentimplantation were recruited as the control group. Arachidonic acid (AA) andadenosine diphosphate (ADP) induced platelet aggregations (PLAA, PLADP) weretested using the light transmission aggregometer(LTA). Aspirin and clopidogrel lowresponse were defined as LTA platelet aggregation in response to AA and ADP beingless than20%and40%respectively. The dosage of clopidogrel was doubled with150mg daily for low responders in the study group. PLADP and the clinical eventswere followed up.Results: The incidence of clopidogrel low response was significantly different in thetwo groups, with100%in the study group and27%in the control group (P=0.000).The average PLADP was significantly higher in the study group than that in thecontrol group [(53.6±6.3)%vs (31.9±13.9)%, P=0.000]. PLADPfell from (53.6±6.3)%to (37.0±10.9)%(p=0.000) after the dosage of clopidogrel was doubled in the studygroup. There was no patient who presented aspirin low response in both groups.Conclusion: Clopidogrel low response is a risk factor of ST. Double dose clopidogrel can further inhibit the residual platelet activity, which may decrease the incidence ofstent thrombosis. Part II The efficacy and safety of domestic clopidogrel(Taijia) and imported clopidogrel (Plavix) on CAD patientsundergoing stent implantationObjectives: To explore the efficacy and safety of domestic clopidogrel (Taijia) andimported clopidogrel (Plavix) on CAD patients undergoing stent implantation.Methods: Between February2010and February2011,a total of244patients whounderwent coronary stenting in the First Affiliated Hospital of Nanjing MedicalUniversity were enrolled. Patients were randomly assigned to receive domesticClopidogrel (taijia group, n=120) or Plavix (plavix group,n=124) therapy. The plateletaggregation induced by AA, ADP were tested after taking clopidogrel more than5days by LTA. Aspirin and clopidogrel low response were defined as LTA plateletaggregation in response to AA and ADP being less than20%and40%respectively.The enrolled patients were followed up at one year after discharging.The endpoint was defined as the composite analysis of death, non-fatal myocardialinfarction, stroke, re-hospitalization, and the safety indicators including bleeding,allergy.Results: The baseline clinical characteristics, angiography and PCI result wascomparable between the two groups. The incidence of clopidogrel low response hasno significantly different in the two groups (32.5%vs33.9%, p>0.05). The plateletaggregation induced by AA, ADP has no significant difference between the twogroups. There was no patient who presented aspirin low response in both groups. Atone year follow-up, no significant difference existed in death rate(0.83%vs0.81%),non-fatal Ml(1.67%vs1.61%), re-hospitalization(14.2%vs12.1%),bleeding(3.33% vs4.84%), allergy(0.83%vs0.81%) between the two groups.Conclusions: The domestic clopidogrel have the same clinical, anti-plateletaggregation effect as the imported clopidogrel, and the safety are comparable.