The ELAPSE (Evaluation of Long-Term Clopidogrel Antiplatelet and Systemic Anti-Inflammatory Effects) Study

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:52

Article

Saw, Jacqueline¹  Madsen, Esben Hjorth⁴  Chan, Sammy⁴  Maurer-Spurej, Elisabeth^2,3,4,5 

[1] Vancouver Gen Hosp, Div Cardiol, Vancouver, BC V5Z 1M9, Canada

[2] Univ British Columbia, Dept Pathol & Lab Med, Vancouver, BC V5Z 1M9, Canada

[3] Univ British Columbia, Ctr Blood Res, Vancouver, BC V5Z 1M9, Canada

[4] Canadian Blood Serv, Vancouver, BC, Canada

[5] St Pauls Hosp, Div Cardiol, Vancouver, BC V6Z 1Y6, Canada

关键词: aspirin;    clopidogrel;    platelet aggregation;    platelet activation;    inflammation;   

DOI  :  10.1016/j.jacc.2008.08.047

来源: Elsevier

【 摘 要 】

Objectives This study was designed to evaluate the effects of long-term clopidogrel and aspirin administration on platelet aggregation, activation, and inflammation. Background Clopidogrel resistance was described in 15% to 30% of patients with short-term therapy, but its antiplatelet effects with long-term therapy is unknown. Methods We performed a prospective study of patients undergoing coronary stenting who were on aspirin for >= 5 days but not previously on clopidogrel. Clopidogrel 600 mg was given before stenting. Clopidogrel 75 mg/day and aspirin 325 mg/day were continued for 1 year. Light-transmittance aggregometry with 5-mu mol/l adenosine diphosphate and 1-mmol/l arachidonic acid stimulation; VerifyNow clopidogrel and aspirin assays; platelet activation receptor expression of CD40L, CD62P, and PAC-1 (antibody against activated glycoprotein IIb/IIIa); and inflammatory markers of soluble CD40L and P-selectin, high-sensitivity C-reactive protein, interleukin-10, and interleukin-18 were measured at baseline; 1 day; and 1, 6, and 12 months. Our primary analysis compared light-transmittance aggregometry aggregation at 1 versus 12 months. Results We enrolled 26 patients who completed a 1-year follow-up. Maximal platelet adenosine diphosphate-stimulated aggregation was 61.8 +/- 25.9% at baseline, 22.1 +/- 18.3% at 1 day, 30.6 +/- 16.8% at 1 month, 29.0 +/- 13.3% at 6 months, and 26.7 +/- 13.6% at 12 months (p = 0.099 for 12 months vs. 1 month). VerifyNow clopidogrel platelet inhibition was similar at 12 months versus 1 month (38.9 +/- 19.7% vs. 45.6 +/- 26.7%, p = 0.578). Likewise, there was no difference in aspirin's effects on platelet aggregation at 12 months versus 1 month. In contrast, platelet activation receptor expression of CD40L, CD62P, and PAC-1 were higher at 12 months versus 1 month. Conclusions Our pilot study showed no attenuation of clopidogrel's effects on platelet aggregation with long-term administration. However, platelet activation receptor expression increased with time and should be further evaluated. (J Am Coll Cardiol 2008; 52: 1826-33) (c) 2008 by the American College of Cardiology Foundation

【 授权许可】

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