Objective. To determine whether nonresponsiveness to clopidogrel as revealed by high in vitro residual platelet reactivity after a 600 mg loading of the drug is predictive of drug-eluting stent thrombosis and cardiac mortality at long-term follow-up. Background.
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To determine whether nonresponsiveness to clopidogrel as revealed by high in vitro residual platelet reactivity after a 600 mg loading of the drug is predictive of drug-eluting stent thrombosis and cardiac mortality at long-term follow-up
The RECLOSE trial showed that nonresponsiveness to clopidogrel is predictive of drug-eluting stent (DES) thrombosis and cardiac mortality at 6 months. No data exist about the predictive value of long-term adverse events in patients with DES and clopidogrel loading non-responsiveness
Platelet-rich plasma was stimulated with 10 M ADP and aggregation was assessed using LTA. Patients with platelet aggregation by 10 µmol ADP ≥ 90th percentile of controls (70%) were defined as nonresponders.
AND at least ONE additional criteria:
Secondary end-point: compositeofcardiacmortalityandstentthrombosis
LONG-TERM SURVIVAL FOR PRIMARY END-POINT
97 ± 1
Log rank p <.001
89 ± 3
Event-free survival %
(definite or probable stent thrombosis)
n=803 pts; median time follow-up 639 days - IQ 555-756
(after six months)
(after six months)
High residual platelet reactivity after 600 mg loading dose of clopidogrel, as revealed by a single assessment with LTA, is a strong predictor of cardiac death and DES thrombosis.