Dual Antiplatelet Therapy Clopidogrel with Low-dose Cilostazol Intensifies Platelet Inhibition in Patients with Ischemic Stroke
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概要
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Objective We previously reported that the antiplatelet action is intensified with combined use of clopidogrel and cilostazol in ischemic stroke patients using the VerifyNow P2Y12 Assay. In this study, the relationship between the cilostazol dose and the platelet function achieved with combination therapy was investigated. Methods The subjects included 231 patients with noncardiogenic ischemic stroke treated at our hospital (18 patients treated with a combination of clopidogrel (75 mg) and cilostazol (100 mg), 52 patients treated with a combination of clopidogrel (75 mg) and cilostazol (200 mg), 126 patients treated with clopidogrel (75 mg) alone and 35 patients treated with cilostazol (200 mg) alone). The platelet function achieved with 20 μM of adenosine diphosphate was measured using the VerifyNow P2Y12 Assay. Clopidogrel resistance was defined as P2Y12 Reaction Units (PRU) >230 and/or % inhibition <20%. Results The PRU was >230 in 32 patients (25.4%) receiving clopidogrel alone, one patient (5.6%) receiving combination therapy with cilostazol (100 mg) and one patient (1.9%) receiving combination therapy with cilostazol (200 mg). The rate of PRU >230 was significantly lower in both of the cilostazol combination groups than in the clopidogrel alone group. The percent inhibition was <20% in 41 patients (32.5%) receiving clopidogrel alone, one patient (5.6%) receiving a combination with cilostazol (100 mg) and one patient (1.9%) receiving a combination with cilostazol (200 mg). The rate of % inhibition <20% was significantly lower in both of the cilostazol combination groups than in the clopidogrel alone group. Conclusion Clopidogrel resistance was clearly decreased with combination clopidogrel (75 mg) and low-dose (100 mg) cilostazol therapy. The use of combination therapy with clopidogrel and low-dose cilostazol may be one means of overcoming clopidogrel resistance.
著者
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Tanahashi Norio
Department Of Anesthesiology Osaka University Medical School
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Fukuoka Takuya
Department Of Marine Biotechnology Faculty Of Engineering Fukuyama University
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Hayashi Takeshi
Department Of Computer Science And Systems Engineering Graduate School Of Engineering Kobe Universit
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Kato Yuji
Department Of Agricultural Chemistry Faculty Of Agriculture Tohoku University
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Nagoya Harumitsu
Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University
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Deguchi Ichiro
Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University
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Maruyama Hajime
Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University
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Ohe Yasuko
Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Japan
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Horiuchi Yohsuke
Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Japan
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Kato Yuji
Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Japan
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