Abstract 1318: A Mechanistic Link between High Platelet Reactivity, Inflammation Marker Release and Myonecrosis in Patients Undergoing Stenting: CLEAR PLATELETS-Ib Study
Background: Few data exist regarding the comparative effects of specific antiplatelet regimens on early inflammation marker release following stenting. The current study was performed to compare the effects of antiplatelet regimens on early inflammation and cardiac marker release following elective stenting.
Methods: In the CLEAR PLATELETS (a 2×2 factorial randomized investigation) patients undergoing stenting were treated with either clopidogrel alone (n =60, 300 mg or 600 mg) or clopidogrel with eptifibatide (n=60). Platelet aggregation (5 and 20 uM ADP), ADP-stimulated expression of active glycoprotein (GP) IIb/IIIa and platelet-bound P-selectin, tumor necrosis factor (TNF)-α, C-reactive protein (CRP) and cardiac markers were measured.
Results: Compared to a strategy of clopidogrel alone, clopidogrel + eptifibatide reduced the release of cardiac markers. A marked reduction in platelet aggregation and active GPIIb/IIIa expression (p<0.001) with clopidogrel + eptifibatide was associated with a decrease in CRP and TNF-α release (p<0.001) that resulted in the lowest levels of these markers.(Figure⇓)
Conclusions: A strategy of clopidogrel with GPIIb/IIIa blockade resulted in superior inhibition of inflammation and cardiac marker release that was accompanied by superior platelet inhibition immediately after PCI compared with a strategy of clopidogrel alone. The mechanistic and clinical implications of attenuated periprocedural inflammation and myocardial necrosis with a strategy of GPIIb/IIIa inhibition warrants further investigation.