Effects of intensive antiplatelet therapy in patients with high platelet aggregability after percutaneous coronary intervention

Objective Post percutaneous coronary intervention(PCI)major cardiac event rate is high in patients with high platelet aggregability.We observed the effects of intensive antiplatelet therapy in these patients.Methods ADP-induced platelet inhibition rates were less than 30% after 24 h treatment with Clopidogrel(300 mg)in 402 patients out of 1556 patients who underwent PCI in our institute between January 2004 to June 2006.These patients were randomly divided into control group(Clopidogrel 75 mg/d and aspirin 100 mg/d,n=201)or treatment group(Clopidogrel 75 mg/d and aspirin 100 mg/d plus cilostazol 200 mg/d,n=201).Major adverse cardiac events were analyzed after 6 months treatments. Results Patients with ADP-induced platelet inhibition rates30% were significantly lower in treatment group compared to control group after 28 days treatments(9.4% vs.89.6%,P0.05).Thrombosis complication(0.5% vs.3.0%),death(0 vs.1.0%),non-fatal myocardial infarction(0.5% vs. 1.5%),hemorrhagic(6% vs.4%)rates were similar between treatment and control group while target vessel revascularization rate was significantly lower in treatment group compared to control group(6.5% vs. 15.9%,P0.05).Total MACE rate was therefore significantly lower in treatment group than that in control group(13.5% vs.25.4%,P0.05).Conclusion Intensive anti-platelet treatment could significantly reduce major cardiac event rates in patients with high platelet aggregability after percutaneous coronary intervention.