Effect of adjunctive dipyridamole to DAPT on platelet function profiles in stented patients with high platelet reactivity

Yongwhi Park; Young-Hoon Jeong; Udaya S. Tantry; Jong-Hwa Ahn; Kye Hwan Kim; Jin-Sin Koh; Jeong-Rang Park; Seok-Jae Hwang; Choong Hwan Kwak; Jin-Yong Hwang; Paul A. Gurbel

doi:10.1160/th14-01-0040

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2014; 112(06): 1198-1208
DOI: 10.1160/th14-01-0040

Platelets and Blood Cells

Schattauer GmbH

Effect of adjunctive dipyridamole to DAPT on platelet function profiles in stented patients with high platelet reactivity

The Result of the ACCEL-DIP Study

Authors

Yongwhi Park

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
Young-Hoon Jeong

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
Udaya S. Tantry

²Sinai Center for Thrombosis Research, Baltimore, Maryland, USA
Jong-Hwa Ahn

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
Kye Hwan Kim

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
Jin-Sin Koh

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
Jeong-Rang Park

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
Seok-Jae Hwang

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
Choong Hwan Kwak

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
Jin-Yong Hwang

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
Paul A. Gurbel

²Sinai Center for Thrombosis Research, Baltimore, Maryland, USA

Abstract

Summary

Adjunctive use of phosphodiesterase (PDE) inhibitor can enhance antiplatelet and vasoprotective properties in patients with cardiovascular disease. The aim of this study was to evaluate the impact of PDE5 inhibitor dipyridamole on platelet function in stented patients with high platelet reactivity (HPR) during dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. Patients with HPR after 600-mg clopidogrel loading were randomly assigned to adjunctive dipyridamole 75 mg twice daily to standard DAPT (DIP group; n = 45) or double-dose clopidogrel of 150 mg daily (DOUBLE group; n = 46) for 30 days. Platelet function was assessed at baseline and 30-day follow-up with platelet reactivity index (PRI) by vasodilator-stimulated phosphoprotein-phosphorylation (VASP-P) assay and platelet aggregation (PA) by light transmittance aggregometry (LTA). Primary endpoint was PRI at 30-day follow-up. HPR was defined as PRI > 50%. Baseline platelet function did not differ between the groups. Following 30-day therapy, platelet function was significantly reduced in the DIP and DOUBLE groups (all p-values ≤ 0.004 and ≤ 0.068, respectively). PRI values were not significantly different between the two groups (mean difference: 3.1%; 95% confidence interval: –2.8% to 9.0%: p = 0.295). PA values and prevalence of HPR were similar between the groups. However, a significant number of patients still exhibited HPR in the DIP (75.6%) and DOUBLE (67.4%) groups. In conclusion, among stented HPR patients, adding dipyridamole to DAPT does not reduce platelet reactivity and prevalence of HPR compared with double-dose clopidogrel therapy, and therefore both strategies are inadequate to overcome HPR.

Keywords

Platelets - dipyridamole - clopidogrel - intervention

Full Text

References

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