Coronary artery disease
Effects of Triple Antiplatelet Therapy (Aspirin, Clopidogrel, and Cilostazol) on Platelet Aggregation and P-Selectin Expression in Patients Undergoing Coronary Artery Stent Implantation

https://doi.org/10.1016/j.amjcard.2007.03.070Get rights and content

The purpose of this study was to determine the effect of the addition of cilostazol to aspirin plus clopidogrel on platelet aggregation after intracoronary stent implantation. Twenty patients who underwent coronary stent placement were randomly assigned to therapy with aspirin plus clopidogrel (dual-therapy group, n = 10) or aspirin plus clopidogrel plus cilostazol (triple-therapy group, n = 10). A loading dose of clopidogrel (300 mg) and cilostazol (200 mg) was administered immediately after stent placement, and clopidogrel (75 mg/day) and cilostazol (100 mg twice daily) were given for 1 month. Platelet aggregation in response to adenosine diphosphate (ADP; 5 and 20 μmol/L) or collagen and P-selectin (CD-62P) expression was assayed at baseline, 2 hours, 24 hours, 1 week, and 1 month after stent placement. Inhibition of ADP-induced platelet aggregation was significantly higher in patients receiving triple therapy than those receiving dual therapy from 24 hours after stent placement, and inhibition of collagen-induced platelet aggregation was significantly higher in the triple-therapy group beginning 1 week after stent placement. P-Selectin expression was significantly lower in the triple-therapy than dual-therapy group at 1 week and 30 days. In conclusion, compared with dual antiplatelet therapy, triple therapy after coronary stent placement resulted in more potent inhibition of platelet aggregation induced by ADP and collagen. These findings suggest that triple therapy may be used clinically to prevent thrombotic complications after coronary stent placement.

Section snippets

Methods

The 20 patients awaiting elective coronary stent implantation were randomly assigned to treatment with aspirin plus clopidogrel (dual-therapy group, n = 10) or aspirin plus clopidogrel plus cilostazol (triple-therapy group, n = 10) after coronary angiography. All patients received aspirin (200 mg/day) for ≥1 week before coronary intervention. Loading doses of clopidogrel (300 mg) and cilostazol (200 mg) were administered immediately after stent placement, and patients were maintained on

Results

There were no significant differences in patient characteristics between the 2 groups (Table 1). No major adverse cardiovascular events, including death, myocardial infarction, stroke, or stent thrombosis, occurred during the 1-month study period. In addition, there were no serious adverse reactions causing drug discontinuation and no major bleeding episodes requiring transfusion.

Platelet aggregation profiles are shown in Table 2 and Figure 1. At baseline, platelet aggregation induced by ADP

Discussion

We showed here that a triple-therapy regimen of cilostazol, clopidogrel, and aspirin showed more potent inhibition of ADP-induced platelet aggregation than dual therapy with aspirin and clopidogrel. This difference first appeared 24 hours after coronary stent placement and was maintained thereafter, suggesting that clopidogrel and cilostazol had a rapid and persistent action.7, 8, 9 We also found that platelet P-selectin expression and collagen-induced platelet aggregation were not inhibited by

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    This work was supported by the Cardiovascular Research Foundation, Seoul, Korea, and Grant No. 0412-CR02-0704-0001 from the Korea Health 21 R&D Project, Ministry of Health and Welfare, Seoul, Korea.

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    Copyright © 2007 Elsevier Inc. All rights reserved.