Korean J Intern Med.  2014 Mar;29(2):210-216. 10.3904/kjim.2014.29.2.210.

Efficacy and safety of antiplatelet-combination therapy after drug-eluting stent implantation

• Cho YK
• Nam CW
• Park HS
• Yoon HJ
• Kim H
• Hur SH
• Kim YN
• Lee JH
• Yang DH
• Lee BR
• Jung BC
• Kim W
• Park JS
• Lee JB
• Kim KS
• Kim KB

• KMID: 1792037
• DOI: http://doi.org/10.3904/kjim.2014.29.2.210

Abstract

BACKGROUND/AIMS
Combination single-pill therapy can improve cost-effectiveness in a typical medical therapy. However, there is a little evidence about the efficacy and tolerability of combination single-pill antiplatelet therapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES).
METHODS
From June to November 2012, in total, 142 patients who met the following criteria were enrolled: at least 18 years old; successful PCI with DES at least 3 months earlier; and regular medication of aspirin and clopidogrel with no side effects. After VerifyNow P2Y12 and aspirin assays, the combination single pill of aspirin and clopidogrel was given and laboratory tests were repeated 6 weeks later.
RESULTS
At baseline, the incidence of aspirin resistance, defined as aspirin reaction unit (ARU) > or = 550, was 9.2%, that of clopidogrel resistance, defined as P2Y12 reaction unit (PRU) > or = 230, was 46.5%, and that of percent inhibition of PRU < 20% was 32.4%. At follow-up, the incidence of resistance by ARU value was 7.0%, 50.0% by PRU value, and 35.9% by percentage inhibition of PRU, respectively. The mean values of ARU (431.5 +/- 63.6 vs. 439.8 +/- 55.2; p = 0.216) and PRU (227.5 +/- 71.4 vs. 223.3 +/- 76.0; p = 0.350) were not significantly different before versus after antiplatelet-combination single-pill therapy. Five adverse events (3.5%) were observed during the study period.
CONCLUSIONS
Combination single-pill antiplatelet therapy, which may reduce daily pill burden for patients after PCI with DES, demonstrated similar efficacy to separate dual-pill antiplatelet therapy.

Keyword

Aspirin; Clopidogrel; Drug combinations

MeSH Terms

Aged
Antiplatyhelmintic Agents/*administration & dosage/adverse effects
Aspirin/*administration & dosage/adverse effects
Drug Combinations
Drug Resistance
*Drug-Eluting Stents
Female
Humans
Intention to Treat Analysis
Male
Middle Aged
Myocardial Ischemia/blood/diagnosis/*therapy
Percutaneous Coronary Intervention/adverse effects/*instrumentation
Platelet Function Tests
Prospective Studies
Tablets
Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives
Time Factors
Treatment Outcome
Antiplatyhelmintic Agents
Aspirin
Drug Combinations
Tablets
Ticlopidine