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High maintenance dose of clopidogrel in patients with high on-treatment platelet reactivity after a percutaneous coronary intervention

a meta-analysis

Lin, Lua,*; Wang, Hanga,*; Chen, Yi-Fengb; Lin, Wei-Weia; Wang, Chang-Liana; Lin, Cui-Honga

doi: 10.1097/MCA.0000000000000246
Original Research
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Objective High on-treatment platelet reactivity (HTPR) has been linked to cardiovascular (CV) events after a percutaneous coronary intervention. There have been some controversies on whether a high maintenance dose (MD) of clopidogrel is effective for HTPR patients. Thus, we carried out a meta-analysis to assess the efficacy and safety of a high MD of clopidogrel in patients with HTPR.

Methods Searches of PubMed (from 1966 to May 2014), EMBASE (from 1974 to May 2014), and the Cochrane Library (2 May 2014) were performed. All randomized-controlled trials assessing the efficacy and safety of a high MD of clopidogrel in patients with HTPR were included.

Results A total of eight randomized-controlled trials including 3865 patients were included for analysis. In patients with HTPR, high-dose clopidogrel significantly reduced the risk of major adverse CV events or major adverse cardiac and cerebrovascular events [risk ratio (RR) 0.59; 95% confidence interval (CI) 0.39–0.88], stent thrombosis (RR 0.43; 95% CI 0.20–0.92), and target vessel revascularization (RR 0.31; 95% CI 0.10–0.93), without increasing major bleeding (RR 0.75; 95% CI 0.43–1.31) compared with standard-dose clopidogrel.

Conclusion A high MD of clopidogrel may be a feasible and readily available treatment to lower the risk of recurrent CV events in patients with HTPR after undergoing percutaneous coronary intervention, especially in HTPR patients with coronary artery disease and chronic kidney disease.

aDepartment of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou

bDepartment of Pharmacy, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, People’s Republic of China

* Lu Lin and Hang Wang contributed equally to the writing of this article.

Correspondence to Chang-Lian Wang, BScPharm, Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Taijiang, Fuzhou 350005, People’s Republic of China Tel: +86 591 8798 1331; fax: +86 591 8798 1331; e-mail: wcl@medmail.com.cn

Received January 16, 2015

Received in revised form February 21, 2015

Accepted March 2, 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.