Die hemmende Wirkung von Clopidogrel auf die Aggregation humaner Thrombozyten

摘要: Platelets are major players in pathophysiology of cardiovascular diseases man and animals. Therefore, antiplatelet strategies an important element human medicine (e.g., for prevention thrombotic events after vascular interventions). Current guidelines recommend dual therapy with clopidogrel 75 mg qd acetylsalicylic acid 100mg patients undergoing elective coronary stent implantation. However, several studies demonstrated a high interindividual variability response to significant impact on clinical outcome. For instance, the EXCELSIOR study showed that insufficient (defined as >14% aggregation stimulation ADP 5 µM) loading 600 had 3-fold higher incidence death non-fatal myocardial infarction within one year stenting. Therefore, current prospective aimed investigate if on-treatment platelet reactivity standard dosing can be overcome by increased regimen. Antiplatelet effects were assessed light transmission aggregometry (stimulation µmol/L) at day 1 subsequent Out 117 enrolled, 39 identified having residual >14%. These received additional bolus 300 intensified maintenance regimen 150 per day. Patients ≤14% treated according labelled (75 qd). Platelet was 2 4 weeks PCI. Data from 57 without any adjustment dose served control. The decreased significantly compared baseline assessments despite persisting substantial inter-individual variability. Median group adaption slightly but adequate initial treatment throughout. results confirmed tests such concentrations (20 analysis surface protein expression platelets. After increasing clopidogrel, no dose-related increase systemic exposure parent or inactive metabolite carboxy-clopidogrel could determined which most likely attributed large pharmacokinetics clopidogrel. The not associated evidence bleeding. present sufficiently powered detect differences regards safety. In conclusion, selective adaptation is feasible way achieve better inhibition findings open field scale investigating tailored individualized antiplatetet outcome percutaneous interventions.