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High residual platelet reactivity predicts future cardiovascular events
With the increased use of platelet function testing, high residual platelet reactivity (HRPR) has been found to be associated with a high risk of ischaemic events following percutaneous coronary intervention. However, few data exist for patients with acute coronary syndrome (ACS). To this end, the RECLOSE 2-ACS (Responsiveness to Clopidogrel and Stent Thrombosis 2-ACS) Study investigated the hypothesis that HRPR after clopidogrel loading is an independent prognostic marker of risk of long-term thrombotic events in patients with ACS undergoing an invasive procedure, even when the long-term antithrombotic treatment was adjusted according to the results of the platelet function tests.
The study included 1789 consecutive patients with ACS recruited over a 4-year period, in whom platelet reactivity was prospectively assessed by light transmittance aggregometry. All patients received 325 mg of aspirin and a loading dose of 600 mg of clopidogrel, followed by a maintenance dosage of 325 mg/day aspirin and 75 mg/day clopidogrel for at least 6 months. Patients with HRPR as assessed by an ADP test (≥70% platelet aggregation) received an increased dose of clopidogrel (150–300 mg/day) or switched to ticlopidine (500–1000 mg/day) under ADP test guidance. The primary end point was a composite of cardiac death, myocardial infarction, any urgent coronary revascularisation and stroke at …