Patti G, Grieco D, Dicuonzo G et al. J Am Coll Cardiol 2011;57:771–8.
In the randomized ARMYDA-150 mg (Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty) trial, the present authors evaluated the biochemical effect of doubling the dose of clopidogrel (from 75 mg/day to 150 mg/day) in patients with stable angina or non-ST-segment elevation ACS undergoing percutaneous coronary intervention. They showed that patients receiving the doubled dose had greater platelet inhibition, better flow-mediated vasodilation, and a lower level of inflammation compared with those receiving the standard dose. No clinical outcome was studied in this small randomized trial, and patients who had high on-treatment platelet reactivity were not specifically targeted. In light of the recently presented GRAVITAS (Gauging Responsiveness with a VerifyNow® Assay – Impact on Thrombosis and Safety) trial data, which showed no clinical benefit to doubling the dose of clopidogrel in patients with high on-treatment platelet reactivity, further investigation is needed to establish the appropriate intensity of antiplatelet therapy for individual patients.
ARMYDA-150 mg (Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty) was a randomized crossover trial of 50 patients undergoing percutaneous coronary intervention (PCI) for either stable angina or non-ST-segment elevation ACS. Patients first received the standard dose of clopidogrel (75 mg/day) for 30 days post-PCI, after which they were randomized to either continue receiving the standard dose or to receive a doubled dose (150 mg/day). Crossover of treatments occurred 30 days later. Measurements of platelet reactivity, brachial artery reactivity, and C-reactive protein (CRP) levels were obtained at randomization, crossover, and 30 days after crossover. Notably, drugs that have been shown to interact with clopidogrel, including certain statins and proton pump inhibitors (PPIs), were excluded.