Copyright © 1998 by the European Society of Cardiology.
Effects of clopidogrel, aspirin and combined therapy in a porcine ex vivo model of high-shear induced stent thrombosis
a Cardiovascular Interventional Research Center, Division of Cardiology, Department of Medicine, The Burns and Allens Research Institute, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA, U.S.A
b Sanofi Recherche, Toulouse, France
accepted March 12, 1998
Aims Use of ticlopidine in coronary stenting is limited by delayed onset of action. We studied the effects of clopidogrel, a rapidly acting analog of ticlopidine alone, and in combination with aspirin, in inhibiting stent thrombosis.|P[s8|P]Methods
Unpolished nitinol stents were deployed in a porcine ex vivo arteriovenous shunt and exposed to flowing arterial blood at a shear rate of approximately 1500.s–1. Stent thrombus, platelet aggregation and bleeding times were measured at baseline and after treatment.|P[s8|P]Results
Intravenous clopidogrel produced a rapid (within 30min) and dose-dependent inhibition of stent thrombosis, with 87% reduction at a dose of 10mg.kg–1(P<0·001). Aspirin alone (10mg.kg–1) was minimally effective (20% inhibitionP>0·05) in inhibiting stent thrombosis. Combined treatment with clopidogrel and aspirin produced 95–98% inhibition of stent thrombosis, even at low doses of clopidogrel (2·5–5·0mg.kg–1) (P<0·0001). At effective doses both clopidogrel and combined therapy produced significant prolongation of bleeding time (P<0·05) and inhibition of platelet aggregation (P<0·05).
Conclusion Clopidogrel, either alone or combined with aspirin, may have a potential role in preventing stent thrombosis in high-risk clinical situations.
Key Words: Stent • platelets • angioplasty • stent thrombosis
f1 Correspondence: Raj R. Makkar, MD, Division of Cardiology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, U.S.A.
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