ENHANCEMENT OF PLATELET INHIBITION OF TICLOPIDINE PLUS ASPIRIN VS ASPIRIN ALONE GIVEN PRIOR TO ELECTIVE PTCA

Background In man. patients today, elective percutaneous transluminal coronary angioplasty is followed by implantation of coronary stents to achieve optimal results. The current medical strategy to prevent earl y reocclusion is the inhibition of platelet aggregation by administrat ion of. ticlopidine, in addition to aspirin, immediately after the pro cedure. Tn order to inhibit platelet aggregation as early as possible, many centres begin to treat patients with additional ticlopidine the day before elective coronary intenvention. The aim of this study was t o determine the effect of this strategy on platelet aggregation before angioplasty. Method Fifty-two consecutive patients admitted to hospit al for elective balloon angioplasty were prospectively randomized to r eceive either standard oral aspirin 100 mg per day or standard therapy plus 250 mg ticlopidine at the time of admission and the morning befo re angioplasty. Adenosine diphosphate-, collagen- and epinephrine-indu ced platelet aggregation was measured immediately before the procedure by an investigator who was blinded concerning the arm of therapy. Res ults The two groups of patients were comparable in terms of age, sex, body mass index, anginal state, time interval between application of s tudy drug and coronary intervention. Patients on aspirin and ticlopidi ne had a mean maximal platelet aggregation of 36 +/- 12% with adenosin e diphosphate as agonist. For the control group, 54 +/- 12% was measur ed (P < 0.001). Myocardial infarction or emergency coronary bypass gra fting did not occur in either group. Local haemorrhagic complications at the arterial access site occurred in five (aspirin) and sis (aspiri n and ticlopidine) patients (P=ns) none of them requiring blood transf usion. Conclusion The additional application of ticlopidine to chronic aspirin therapy the day before elective coronary balloon angioplasty leads to a significantly higher inhibition of platelet aggregation at the time of the intervention. It seems to be safe compared to the stan dard procedure.