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ȣ - 510811 314 |
| The effect of additional cilostazol for the ADP induced platelet aggregation and soluble CD40L after primary percutaneous coronary interventions |
| 연세대학교 원주의과대학 원주기독병원 순환기내과 |
| 이경훈, 이승환, 윤영진, 김성윤, 신명상, 안민수, 김장영, 유병수, 윤정한, 최경훈 |
Background Cilostazol increases in cyclic adenosine monophosphate levels in platelets and might ameliorate the antiplatelet activity of clopidogrel. This study investigated the additional effect of cilostazol for the platelet aggregation measured by a VerifyNow analyzer and soluble CD40 ligand (sCD40L) as a marker of the activated platelet in patients undergoing primary percutaneous coronary intervention (PCI).
Methods : Patients with ST elevation myocardial infarction undergoing primary PCI were randomly assigned 50 of dual antiplatelet therapy (aspirin and clopidogrel, age; 62.6 ± 10.2) and 50 of triple regimen (dual plus cilostazol, age; 61.3 ± 11.1) groups. Loading dosage (aspirin 300mg, clopidogrel 600mg and cilostazol 400mg in triple regimen) was medicated prior to 1-2 hours before PCI. Aspirin 100mg and clopidogrel 75mg qd was administrated in dual group and additional cilostazol 100mg bid was administrated in triple group. The antiplatelet effects of aspirin and clopidogrel were evaluated by VerifyNow™ tests. The plasma sCD40L levels at admission, 24 hours, and 21 days were measured by the ELISA method.
Results : Baseline clinical and laboratory characteristics were similar in both groups including initial sCD40L ( 261.5 ± 452.8 vs. 279.0 ± 375.1 pg/mL, p=0.838). The aspirin-induced platelet aggregation was similar in both groups. However, the triple group was significantly lower the P2Y12 reaction unit (dual; 197.8±72.9 vs. triple 166.2±87.4, p=0.049) and higher the % inhibition of P2Y12 receptor (dual 28.7±20.9 vs. triple 43.1±24.9 %, p=0.002). In multivariate analysis, cilostazol was the negative predictor for low responders to clopidogrel (95% confidence interval; 0.067-0.711). The plasma sCD40L levels were no significant differences between the two groups at the same point of time. Major adverse cardiac event developed in 2 patients of dual group and 2 of triple group.
Conclusions : The addition of cilostazol to the combination of aspirin plus clopidogrel significantly increases in the inhibition of P2Y12-induced aggregation. However, there was no additive effect on aspirin-induced antiplatelet activity or lowering of sCD40L.
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