Effect of 150-mg vs 300-mg Loading Doses of Clopidogrel on Platelet Function in Japanese Patients Undergoing Coronary Stent Placement

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Background The loading dose of ticlopidine is 500 mg in both the US and Europe and 200 mg in Japan. A lower loading dose of clopidogrel might achieve adequate platelet inhibition in Japanese patients. Methods and Results Platelet aggregation was serially measured at baseline, and 2, 4, 6, and 8h after 150-mg (n=20) and 300-mg (n=20) clopidogrel loading. Platelets were stimulated with 5 and 20μmol/L adenosine diphosphate (ADP) and aggregation was assessed by optical aggregometry. Pretreatment ADP-induced platelet aggregation in the 150-mg clopidogrel group did not differ from that of the 300-mg group. The administration of 300-mg clopidogrel loading dose resulted in lower platelet aggregation 2h after the administration (5μmol/L ADP: 53±9% vs 61±12%, p<0.05 and 20μmol/L ADP: 61±10% vs 68±9%, p<0.05). A lower platelet aggregation induced with 20μmol/L ADP was still observed 4h after the 300-mg clopidogrel loading (58±10% vs 65±9%, p<0.05). Conclusions The 150-mg clopidogrel loading does not achieve rapid platelet inhibition. The 300-mg loading dose should be used to suppress platelet function rapidly even in Japanese patients undergoing coronary stent placement.
社団法人日本循環器学会の論文
2008-07-20