AS-53: The Combination of Warfarin and Dual Antiplatelet Therapy after Coronary Stenting in Patients...

Pharmacological Treatment

Pharmacological Treatment I

Ida I

Wednesday, April 28, 20104:00 PM � 5:00 PM

(Abstract nos. AS-52, AS-54, AS-56, AS-59)

Pharmacological Treatment II

Ida I

Wednesday, April 28, 20105:00 PM � 6:00 PM

(Abstract nos. AS-53, AS-55, AS-57, AS-58,AS-60)

AS-52Cytochrome 2C19 Polymorphism and Response to AdjunctiveCilostazol versus High-Maintenance-Dose Clopidogrel in PatientsUndergoing Percutaneous Coronary Intervention: Results of theACCEL-POLYMORPHISM Study. Young-Hoon Jeong,Seok-Jae Hwang, In-Suk Kim, Yongwhi Park, Choong Hwan Kwak,Jin-Yong Hwang. Gyeongsang National University Hospital, Jinju,Republic of Korea.

Background: Carriers of the cytochrome (CYP) 2C19 variant allelehave shown decreased response to clopidogrel and a higher rate ofischemic events after percutaneous coronary intervention (PCI). Al-though adjunctive cilostazol with dual antiplatelet therapy (ie, tripleantiplatelet therapy) intensifies platelet inhibition, it remains unknownwhether adjunctive cilostazol can overcome the loss-of-function effectof the CYP2C19 polymorphism.

Methods: The CYP2C19 genotyping was performed in 134 pa-tients undergoing elective PCI. After measurement of preproceduralplatelet reactivity (PR), patients were randomly assigned to receiveeither adjunctive cilostazol 100 mg twice daily (triple group; n � 65)or high-maintenance-dose (MD) clopidogrel of 150 mg/day (high-MDgroup; n � 69). PR was assessed immediately before procedure andafter 30 days of therapy by conventional aggregometry and the Veri-fyNow P2Y12 assay. Primary endpoint was absolute change of aden-osine diphosphate (ADP)-induced maximal PR (PRmax). High-post-clopidogrel PR (HPPR) was defined as PRmax �50% with 5 �mol/LADP.

Results: In noncarriers of the CYP2C19 mutant allele, the triplegroup (n � 22) showed similar reductions of PR compared with thehigh-MD group (n � 22). After 30 days of therapy, the rate of HPPRalso did not differ between the triple vs high-MD group (4.5% vs13.6%, p � 0.300). In carriers of at least 1 CYP2C19 mutant allele,

changes of 5 or 20 �mol/L ADP-induced PRmax were significantlyhigher in the triple (n � 47) vs high-MD group (n � 43; 25.8 � 16.8%vs 11.1 � 19.8%, p �0.001; 26.3 � 16.0% vs 11.5 � 16.3%, p�0.001, respectively; Table). Likewise, changes of ADP-induced latePR were consistently greater in the triple vs high-MD group. Change ofP2Y12 reaction unit in the triple group showed enhanced plateletinhibition than that of the high-MD group (105 � 75 vs 64 � 76, p �0.012). After 30 days of therapy, fewer patients in the triple group hadHPPR compared with the high-MD group (6.4% vs 37.2%, p � 0.001).

Conclusion: Among patients with the CYP2C19 mutant alleleundergoing elective PCI, adjunctive cilostazol achieves intensifiedplatelet inhibition and reduces the rate of HPPR compared withhigh-MD clopidogrel.

AS-53The Combination of Warfarin and Dual Antiplatelet Therapyafter Coronary Stenting in Patients with Indications for ChronicOral Anticoagulation: A Systematic Review and Meta-Analysis.Fei Gao, Yu Jie Zhou, Zhi Jian Wang, Ying Xin Zhao, Yu Yang Liu,Dong Mei Shi, Xiao Li Liu, Bin Nie, Zhen Xian Yan, Shi Wei Yang,Hong Ya Han, De An Jia. An Zhen Hospital, Beijing, China.

Background: The optimal antithrombotic strategy for patients withchronic oral anticoagulation undergoing coronary stenting is unknown.Our study conducted a meta-analysis of 9 previous trials comparing thesafety and efficacy of triple antithrombotic regimen (including warfa-rin, aspirin, and clopidogrel) to dual antiplatelets in those patients.

Methods: Two investigators independently searched PubMed,Ovid, and Elsevier databases for all reported studies, yielding 9 (of 242potentially relevant) articles, published before July 2009, enrolling5181 patients; follow-up period ranged from 1 month to 18 months.Two coauthors independently recorded data regarding interventionsand the occurrence of ischemic stroke, major bleeding, myocardialinfarction, and death.

Results: Patients with triple antithrombotic regimen had a signifi-cant reduction in ischemic stroke (odds ratio [OR] 0.29, 95% confi-dence interval [CI] 0.15–0.58; p � 0.0004) as compared with dualantiplatelet therapy. Although there was a 2-fold increased risk ofmajor bleeding associated with triple antithrombotic regime (OR 2.0,95% CI 1.41–2.83; p �0.0001). The overall incidence of death (OR0.85, 95% CI 0.60–1.20; p � 0.36) and myocardial infarction (OR0.84, 95% CI 0.57–1.23; p � 0.38) was comparable between the 2regimens.

Conclusion: Our study confirmed the cardiovascular benefits of thetriple antithrombotic regimen by reducing ischemic stroke risk but alsodemonstrated its increased risk of major bleeding. It suggests the needfor future prospective randomized studies to evaluate whether the tripleantithrombotic regimen is superior to the dual antiplatelet strategy inpatients requiring chronic anticoagulation undergoing coronary stent-ing.

AS-54The Influence of Atorvastatin or Rosuvastatin on AntiplateletActivity of Clopidogrel. RuiQin Xie, Wei Cui, Yanping Geng1,Fan Liu, Jing Liu, Xiaohong Yang, Xiuchun Yang. Hebei MedicalUniversity the Second Hospital, Shijiazhuang, China; 1The PeopleHospital of Hebei Province, Shijiazhuang, China.

The American Journal of Cardiology� APRIL 28–29 2010 ANGIOPLASTY SUMMIT ABSTRACTS/Oral 23B

ORAL

ABSTRACTS

Wednesday, April 28, 2010