氯吡格雷与血小板反应

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1、CLEARPLATELETS:ClopidogrelLoadingwithEptifibatidetoArresttheReactivityofPlatelets1IntroductionWehavepreviouslyreportedasignificantincidenceofclopidogrelresistanceinpatientspost-electivecoronarystentingtreatedwithastandard300-mgloadingdose1(31%at24hours)Patientswithclopidogrelresistance/hig

2、hpost-stentplateletreactivitymaybeatgreatestriskofSATandischemicevents2-4Relationofperi-proceduralplateletreactivitytomyocardialnecrosishasneverbeenprospectivelystudiedThesedatasuggestthat300mgclopidogrel/75mgqddoesnotprovidesufficientinhibitioninsomepatientsundergoingelectivecoronarystent

3、ing1.Gurbeletal.Circulation.2003;107:2908.2.Mulleretal.ThrombHaemost.2003;89:783.3.Barraganetal.CatheterCardiovascInterv.2003;59:295.4.Matetzkyetal.Circulation.2004;109:3171.2Introduction(cont’d)Mechanismsofclopidogrelnonresponse/resistanceareincompletelydefined?Duetoinadequatelevelsofacti

4、vemetabolite?OvercomebyahigherdoseStudyof30pts(n=10forticlodipine,n=10forclopidogrel300mg,n=10forclopidogrel600mg)suggestedbetterinhibitionwith600mgat4hoursbutnodifferenceat24hourswith600-mgdose11.Mulleretal.Heart.2001;85:92.3Introduction(cont’d)Alargeprospectivepharmacodynamicstudyofclopi

5、dogrel300mgvs600mgisnotavailableTheeffectofaddingeptifibatidetotheseregimensisunknownISARREACTsuggestednobenefitofaddingabciximabtopatientsloadedwith600mgclopidogrel1Patientsallpretreatedfor2hours(median7.4hours)RiskofbleedingwithCABGinpatientsonclopidogreltherapy2Low-riskgroup1.Kastrati

6、etal.NEnglJMed.2004;350:232.2.Hongoetal.JAmCollCardiol.2002;40:231.4ObjectivesofCLEARPLATELETSTrialCompareplateletreactivityfollowing4treatmentsinlow-tomoderate-riskpatientsundergoingelectivestentingWithoutpretreatment(CRUSADE)coronaryanatomyunknownpriortoprocedureDOSING600mgClopidogrel600

7、mgClopidogrel+eptifibatide300mgClopidogrel300mgClopidogrel+eptifibatideAnalyzetherelationofplateletreactivitytopostproceduralmyocardialnecrosisAnalyzetherelationofplateletreactivitytopostproceduralinflammationGurbeletal.Circulation.2005;111:1153.5MethodsCons