From the Department of Medicine II, Johannes Gutenberg University, Mainz,
Germany.
Correspondence to Hans-Jürgen Rupprecht, MD, Department of Medicine II, Johannes Gutenberg-University, Langenbeckstr 1, D-55101 Mainz, Germany.
Background—This study was performed
to analyze the influence of either aspirin, ticlopidine, or
their combination on platelet activation and aggregation
parameters after stent implantation.
Methods and Results—Sixty-one patients with successful
implantation of a single Palmaz-Schatz stent in a native
coronary artery were randomly assigned to either group A
(aspirin 300 mg/d+ticlopidine 2x250 mg/d), group B (ticlopidine 2x250
mg/d), or group C (aspirin 300 mg/d). Platelet activation was
evaluated on days 1, 7, and 14 by flow cytometry measurement of
expression of CD62p (p-selectin) and the binding of fibrinogen to the
platelet surface glycoprotein IIb/IIIa receptor.
Platelet aggregation was induced by addition of ADP or collagen.
Differences between treatment groups were compared by ANOVA. Between
days 1 and 14, we observed a significant decrease in collagen-induced
platelet aggregation in group A (62.2±2.5% versus 36.9±3.1%),
whereas an increase was seen in group B (58.3±2.5% versus
67.7±3.2%) and no change was seen in group C
(P<.0001). The ADP-induced aggregation declined
significantly in group A (74.7±1.4% versus 55.3±2.6%), whereas a
delayed reduction was seen in group B (72.0±3.0% versus 52.6±4.2%)
and no change was seen in group C (P=.0017). The CD62p
expression declined significantly in groups A (68.2±2.7% versus
41.3±2.7%) and B (64.8±2.9% versus 39.3±3.5%) but not in group C
(P<.0001). Moreover, the fibrinogen binding decreased
significantly in group A (61.0±4.3% versus 36.3±4.2%) and with
delay in group B (58.3±2.2% versus 39.4±3.0%), whereas no
alterations were seen in group C (P=.012).
Conclusions—Our results demonstrate synergistic and accelerated
platelet inhibitory effects of ticlopidine plus aspirin
in patients after stent implantation compared with a monotherapy with
either ticlopidine or aspirin alone.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Comparison of Antiplatelet Effects of Aspirin, Ticlopidine, or Their Combination After Stent Implantation
Key Words: stents • platelet aggregation inhibitors • aspirin
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