The potential value of near patient platelet function testing in PCI: randomised comparison of 600mg versus 900mg clopidogrel loading doses

Hobson, A.R., Qureshi, Z., Banks, P. and Curzen, N. (2010) The potential value of near patient platelet function testing in PCI: randomised comparison of 600mg versus 900mg clopidogrel loading doses. Thrombosis, [6pp.]. (doi:10.1155/2010/908272). (PMID:22084661)

Abstract

Whilst poor response to clopidogrel is associated with adverse outcomes uncertainty exists as to how (a) response should be assessed and (b) poor responders managed. We utilised VerifyNow P2Y12 and short Thrombelastography (TEG) to assess 900?mg doses in (i) initial poor responders to 600?mg and (ii) in a randomised comparison with 600?mg. Blood was taken before and six hours post clopidogrel in (i) 30 volunteers receiving 600?mg (poor responders received 900?mg > two weeks later) and (ii) 60 patients randomized 1 : 1 to 600?mg or 900?mg doses. Poor response was defined as TEG %Clotting Inhibition (%CIn) or VerifyNow Platelet Response Unit (PRU) reduction <30%. (i) Poor responders to 600?mg had greater PRU reduction (45.0 versus 20.1%, P = 0.03) and greater %CIn (22.9 versus -15.1%, P = 0.01) after 900?mg but (ii) there were no significant differences between the patient groups. Near-patient assessment of response to clopidogrel is feasible and clinically useful. Whilst ineffective on a population basis 900?mg doses increase the effect of clopidogrel in initial poor responders.

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Contributors

Author: N. Curzen

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