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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EFor patients who undergo nonemergent percutaneous coronary intervention (PCI), tailoring the loading dose of clopidogrel according to platelet reactivity reduced the rate of early stent thrombosis, according to findings from a new trial. Individualized dosing also reduced the incidence of major adverse cardiovascular events without increasing bleeding events.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ethrombotic disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EFor patients who undergo nonemergent percutaneous coronary intervention (PCI), tailoring the loading dose of clopidogrel according to platelet reactivity reduced the rate of early stent thrombosis, according to findings from a new trial. Individualized dosing also reduced the incidence of major adverse cardiovascular events (MACE) without increasing bleeding events.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EFranck Paganelli, MD, H\u00f4pital Universit\u00e9 Nord, Marseilles, France, reported findings from the Tailored Clopidogrel Loading Dose According to Platelet Reactivity Monitoring to Prevent Stent Thrombosis study at the American Heart Association Scientific Sessions meeting in New Orleans.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EClopidogrel resistance has been linked to increased adverse events in patients who are undergoing PCI. Dr. Paganelli and colleagues have been exploring the role of the vasodilator-stimulated phosphoprotein (VASP) index, a measure of platelet reactivity that is specific to the P2Y\u003Csub\u003E12\u003C\/sub\u003E receptor, to guide clopidogrel dosing. The present study examines whether additional loading doses of clopidogrel, based on the VASP index, can overcome problems that are related to clopidogrel resistance, including stent thrombosis and MACE, which have been shown to occur more frequently in patients with elevated platelet reactivity (elevated VASP index).\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe trial included 429 \u201clow responders\u201d to clopidogrel, whose VASP index remained \u226550% (elevated platelet reactivity) after an initial loading dose of clopidogrel 600 mg. These patients were randomly assigned to additional VASP-guided clopidogrel dosing, with the goal of achieving a VASP index \u0026lt;50% (low platelet reactivity) prior to PCI (n=214), or PCI without additional clopidogrel dosing (n=215). In the VASP-guided arm, up to 3 additional loading doses of 600 mg of clopidogrel (maximum clopidogrel dose 2400 mg) were administered before PCI.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EAfter the second clopidogrel dose in the VASP-guided group, 132 patients (61%) had a low VASP index of \u0026lt;50% and proceeded to PCI. Of the remaining patients, 83 (38%) required third doses and 40 (18%) required fourth doses of clopidogrel prior to intervention. The latter group included 17 patients (8%) whose VASP index remained elevated (\u0026gt;50%) despite a total of 2400 mg of clopidogrel. The primary endpoint was the rate of early definite stent thrombosis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EDuring the first 30 days after PCI, 1 patient in the VASP-guided group and 10 patients in the control group experienced stent thrombosis (p\u0026lt;0.01). All thrombotic events occurred within the first 7 days of the 30-day observational period (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/8\/17\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Early Definite Stent Thrombosis During 1-Month Follow-Up.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1501156852\u0022 data-figure-caption=\u0022Early Definite Stent Thrombosis During 1-Month Follow-Up.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/8\/17\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/8\/17\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/8\/17\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11324\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EEarly Definite Stent Thrombosis During 1-Month Follow-Up.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECopyright \u00a9 2003 Massachusetts Medical Society. All rights reserved.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003ETailored clopidogrel dosing also reduced the secondary endpoint of MACE in the VASP-guided group (0.5%) compared with the control group (8.9%; p\u0026lt;0.001). These results included a reduction in myocardial infarction (0.5% vs 4.8%; p=0.01), trends toward fewer cardiovascular deaths (0% vs 1.8%; p=0.06), and urgent revascularizations (0% vs 2.3%; p=0.06).\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EIncreasing clopidogrel dosing up to 2400 mg prior to PCI did not appear to increase bleeding risk. No differences were observed between the VASP-guided and control groups in all TIMI bleeding (3.7% vs 2.8%; p=0.8), major bleeding (0.9% vs 0.9%; p=1.0), or minor bleeding (2.8% vs 1.9%; p=0.8; \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/8\/17\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Secondary Endpoint: TIMI Bleeding.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1501156852\u0022 data-figure-caption=\u0022Secondary Endpoint: TIMI Bleeding.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/8\/17\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/8\/17\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/8\/17\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11327\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003ESecondary Endpoint: TIMI Bleeding.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-12\u0022\u003E\u201cTrying to identify the optimal loading dose using a laboratory test is a very creative idea,\u201d said Elliott Antman, MD, Brigham and Women\u0027s Hospital, Boston, MA. Dr. Antman cautioned that giving iterative loading doses of clopidogrel based on VASP index results takes time, up to 3 days in patients who require third and fourth clopidogrel loading doses. \u201cYou need time for the loading dose to exhibit its effect, and then you need time for the laboratory result to come back,\u201d because bedside testing currently is not available, he said.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EFuture alternatives to clopidogrel therapy, such as prasugrel, AZD 6140, and cangrelor, may provide simpler dosing that is not susceptible to wide variations in treatment response, Dr. Antman said.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/8\/17.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmm9p\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmm9p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}