Study of individualized antithrombus therapy after emergency percutaneous coronary intervention

LI Hui-jun; HU Tao-hong

doi:10.3760/cma.j.issn.1673-4777.2013.03.008

Abstract：Objective To explore the safety and efficacy of an optimized antiplatelet therapy according to laboratory test after coronary stenting.Methods From June 2010 to February 2011,a total of 48 patients who underwent coronary stenting were enrolled.Patients with clot rate (CR) ＞ 23 clot signal/min were randomly assigned to receive optimal therapy (optimal group,n =24) or standard antiplatelet therapy(control group,n =24).Hypercoagulable states was defined as clotrate larger than 23 clot signal/min.The antiplatelet regimen for control group was dual antiplatelet therapy with aspirin and cloidogrel.In optimal group,patients received cilostazol for 1 month in addition to dual antiplatelet therapy.The primary endpoint of present study was the composite analysis of death,myocardial infarction (MI) or stroke.Secondary endpoint was the composite analysis of death,MI,stroke,revascularization or peripheral artery occlusion.Results After cilostazol in addition to dual antiplatelet therapy,CR in optimal group was less than that before treatment [(25.3 ± 1.6) vs (13.6 ± 2.3) clot signal/min,P ＜ 0.01].At one-year follow-up,the patients in optimal group were associated with a 12.5％ reduction in the risk of cardiovascular events compared with those in control group [4.2％ (1/24) vs 16.7％ (4/24),P ＞ 0.05].The incidence of a composite of cardiac death,myocardial infarction,stroke,revascularization or occlusion of lower extremity artery was decreased in optimal group compared with those in control group [8.3％ (2/24)vs 37.5％ (9/24),P ＜ 0.05].No significant difference was shown in incidence of stent thrombosis and hemorrhagic events between the two groups.Conclusions Adjusting antiplatelet regimen according to CR assay results might be effective in improving long-term outcomes for patients undergoing coronary stenting especially for those diagnosed as CR ＞ 23 clot signal/min.However,the effectiveness and safety need further be confirmed by large-scale clinical trials.