CLEAR-PLATELETS 2

14 Dec, 10

Clear-Platelets 2

CLEAR-PLATELETS 2

Adding eptifibatide to bivalirudin therapy in elective stenting significantly reduces platelet reactivity, thrombin-induced fibrin clot and periprocedural MI: CLEAR PLATELETS 2 study.

Aim

To compare the effect of addition of eptifibatide to bivalirudin on platelet reactivity and thrombin-induced fibrin clot in patients undergoing elective PCI with stenting.

Study Groups

Patients on chronic clopidogrel therapy
- Clopidogrel 600 mg + Bivalirudin (600 mg C+B)
- Clopidogrel 600 mg + Bivalirudin + Eptifibatide (600 mg C+B+E)
Clopidogrel naive patients
- Clopidogrel 75 mg + Bivalirudin (75 mg C + B)
- Clopidogrel 75 mg + Bivalirudin + Eptifibatide (75 mg C + B+E)

All patients received aspirin

Primary Outcome Measure

Platelet aggregation with ADP, thrombin receptor activated peptide (TRAP) and collagen thrombin-induced platelet fibrin clot

Results

There was significantly lower platelet aggregation with ADP, TRAP and collagen in patients treated with eptifibatide vs. those not treated with eptifibatide; this effect was immediate and persistent at times (Figure 1)

Figure 1. Comparison of platelet aggregation

*p<0.001, +p< 0.01 versus baseline; #p< 0.001 between groups at the same time point

Thrombin-induced platelet fibrin clot was significantly lower in eptifibatide recipients, indicating a lower risk of post-PCI ischemic events (Figure 2)

Figure 2. Effect on thrombin-induced platelet fibrin clot formation

Addition of eptifibatide significantly reduced periprocedural myocardial infarction, which was assessed by release of myocardial necrosis markers (Figure 3)

Figure 3. Effect on periprocedural infarction

In elective coronary stenting, addition of eptifibatide to bivalirudin therapy in clopidogrel naive and patients on maintenance therapy of clopidogrel produces an immediate and marked reduction in periprocedural platelet aggregation and reduces thrombin-induced platelet fibrin clot.

J Am Coll Cardiol 2009;53:648-57

CLEAR-PLATELETS 2

Clear-Platelets 2

CLEAR-PLATELETS 2

Aim

Patients

Study Groups

Primary Outcome Measure

Results

Conclusion