Effect of Intensive Clopidogrel Therapy in patients with High Perioperative Platelet Aggregation Undergoing Percutaneous Coronary Intervention

Objective To evaluate the efficacy and safety of 150 mg Clopidogrel as maintenance treatment in patients with high perioperative platelet aggregability after percutaneous coronary intervention(PCI).Methods 88 patients out of 375 patients who underwent elective PCI and whose platelet inhibition rates less than 30% in 24 hours after the treatment with Clopidogrel(300mg) were included in our study.These patients with high platelet aggregation were all received aspirin(100mg/day) and randomly divided into conventional treatment group(Clopidogrel 75mg/ day,n =44) and intensive treatment group(Clopidogrel 150mg/day for 28 days,then 75mg/day,n=44).We analyzed major adverse cardiac events(MACE) after 1 year treatment.Results Average period of intensive treatment is 27.8 days.The highest platelet aggregation rates after 28 days treatment in intensive treatment group were significantly lower than those in conventional treatment group(P0.01).Total MACE ratio was significantly lower in intensive treatment group(6.82% vs.22.72%,P0.05).There was no significant difference between the two groups regarding cardiovascular death,non-fatal myocardial infaction,acute and late in-stent thrombosis,major bleeding event.The ratios of subacute in-stent thrombosis and target vessel revascularization in intensive treatment group were significantly lower than those in conventional treatment group(P all0.05).Conclusions A intensive clopidogrel maintenance dose of 150mg/day for 4 weeks after PCI inhibits the platelet aggregation more powerfully and reduces the risk of adverse cardiac events in patients with high perioperative platelet aggregability.