A Double-Blind, Randomized Study on Prevention and Existence of a Rebound Phenomenon of Platelets After Cessation of Clopidogrel Treatment

Dirk Sibbing, Julia Stegherr, Siegmund Braun, Julinda Mehilli, Stefanie Schulz, Melchior Seyfarth, Adnan Kastrati, Nicolas von Beckerath, Albert Schömig

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56 Scopus citations

Abstract

Objectives: The goal of this study was to assess whether a platelet rebound exists and whether it can be attenuated by clopidogrel tapering. Background: Clinical studies have reported a clustering of thrombotic events after stopping clopidogrel treatment. The hypothesis of a rebound phenomenon of platelets has been declared causative, but its existence has never been confirmed. Tapering of clopidogrel over a certain period of time before stopping the drug completely might provide a way to attenuate this supposed phenomenon. Methods: Patients (n = 69) receiving clopidogrel treatment due to prior drug-eluting stent placement and planning to stop clopidogrel were recruited in a double-blind, randomized trial. Patients were randomized to either receive a pre-specified tapering regimen (tapering group; n = 35) for 4 weeks with complete discontinuation of clopidogrel thereafter or continue a daily clopidogrel intake for 4 more weeks with abrupt discontinuation afterwards (off group; n = 34). Platelet aggregation (PA) was assessed with light transmission aggregometry (LTA) and multiple electrode aggregometry (MEA) simultaneously at study inclusion and at weeks 2 to 8 after randomization. The primary end point was the highest value of adenosine diphosphate-induced PA measured with LTA in the weeks after complete cessation of clopidogrel in both groups. Results: The highest values of adenosine diphosphate-induced PA after complete cessation of clopidogrel were similar between both groups (p = 0.21 with LTA, and p = 0.55 with MEA). Conclusions: Tapering of clopidogrel does not result in lower PA values after clopidogrel withdrawal. The course of PA values after clopidogrel cessation provides no evidence for the existence of a rebound phenomenon of platelets.

Original languageEnglish
Pages (from-to)558-565
Number of pages8
JournalJournal of the American College of Cardiology
Volume55
Issue number6
DOIs
StatePublished - 9 Feb 2010
Externally publishedYes

Keywords

  • clopidogrel
  • platelet aggregation
  • platelet rebound

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