Abstract | OBJECTIVES: BACKGROUND: Although adjunctive cilostazol intensifies platelet inhibition in AMI patients, it is not established whether this regimen can be free from the effect of CYP2C19 loss-of-function variants (*2/*3). METHODS: We randomly assigned 126 AMI patients with available CYP2C19 genotyping to receive adjunctive cilostazol (triple group; n = 64) or high maintenance-dose (MD) clopidogrel of 150 mg/day (high-MD group; n = 62). Using conventional aggregometry and VerifyNow (Accumetrics Inc., San Diego, California), platelet reactivity was measured at pre-discharge and 30-day follow-up. Primary endpoint was change in maximal platelet aggregation (ΔAgg(max)) between pre-discharge and 30-day follow-up. High on-treatment platelet reactivity (HPR) was defined as 20 μmol/l adenosine diphosphate-induced maximal platelet aggregation (Agg(max)) >59%. RESULTS: In noncarriers, despite numerically greater inhibition by adjunctive cilostazol, changes in platelet measures and the rate of HPR did not significantly differ between the 2 groups. In carriers, ΔAgg(max) after 5 and 20 μmol/l adenosine diphosphate stimuli was significantly higher in the triple (n = 39) versus high-MD group (n = 38) (21.8 ± 13.9% vs. 9.0 ± 13.3%, p < 0.001, and 24.2 ± 17.2% vs. 7.7 ± 15.5%, p < 0.001, respectively). Likewise, changes in late platelet aggregation and P2Y12 reaction unit were consistently greater in the triple versus high-MD group. Fewer patients in the triple group met the criteria of HPR at 30-day follow-up than in the high-MD group (15.4% vs. 44.7%, p = 0.005). CONCLUSIONS:
|
Authors | In-Suk Kim, Young-Hoon Jeong, Yongwhi Park, Ki-Soo Park, Seong-Eun Yun, Jeong-Rang Park, Seok-Jae Hwang, Eun-Ha Koh, Choong Hwan Kwak, Jin-Yong Hwang, Sunjoo Kim |
Journal | JACC. Cardiovascular interventions
(JACC Cardiovasc Interv)
Vol. 4
Issue 4
Pg. 381-91
(Apr 2011)
ISSN: 1876-7605 [Electronic] United States |
PMID | 21511217
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
|
Copyright | Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Platelet Aggregation Inhibitors
- Tetrazoles
- Adenosine Diphosphate
- Clopidogrel
- Aryl Hydrocarbon Hydroxylases
- CYP2C19 protein, human
- Cytochrome P-450 CYP2C19
- Cilostazol
- Ticlopidine
- Aspirin
|
Topics |
- Adenosine Diphosphate
- Aged
- Angioplasty, Balloon, Coronary
(adverse effects)
- Aryl Hydrocarbon Hydroxylases
(genetics, metabolism)
- Aspirin
(administration & dosage)
- Chi-Square Distribution
- Cilostazol
- Clopidogrel
- Cytochrome P-450 CYP2C19
- Drug Therapy, Combination
- Female
- Genotype
- Humans
- Korea
- Liver
(enzymology)
- Male
- Middle Aged
- Myocardial Infarction
(blood, therapy)
- Phenotype
- Platelet Aggregation
(drug effects)
- Platelet Aggregation Inhibitors
(administration & dosage, adverse effects, pharmacokinetics)
- Platelet Function Tests
- Predictive Value of Tests
- Regression Analysis
- Risk Assessment
- Risk Factors
- Tetrazoles
(administration & dosage, adverse effects, pharmacokinetics)
- Thrombosis
(blood, etiology, prevention & control)
- Ticlopidine
(administration & dosage, adverse effects, analogs & derivatives, pharmacokinetics)
- Treatment Outcome
|