Clopidogrel tapering as a strategy to attenuate platelet rebound phenomenon in patients with bare-metal stents

Idit Yedidya, Adi Netzer, Muthiah Vaduganathan, Alejandro Solodky, Ran Kornowski, Eli I. Lev

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Early clustering of adverse cardiovascular events after abrupt cessation of clopidogrel has been reported in patients with acute coronary syndromes. A platelet rebound phenomenon may contribute to this increased thrombotic risk and a gradual drug tapering may attenuate this proposed platelet effect. Accordingly, we aimed to assess the effect of clopidogrel tapering on platelet reactivity. Twenty patients who underwent elective percutaneous coronary interventions with bare metal stents receiving 3 months of clopidogrel therapy (75 mg daily) were randomized to either of two discontinuation strategies: (1) Off group-abrupt drug cessation or (2) Tapering group-receiving clopidogrel 75 mg every other day for 4 weeks duration. Light transmission aggregometry, induced by ADP (5 and 10 μM) and collagen, was measured at four time-points (at baseline and 2, 4 and 6 weeks after randomization). In the off group, there was an early rise in platelet reactivity at 2 weeks after abrupt drug cessation compared to baseline, as measured by ADP 5 μmol/l (39.6 ± 2.8 vs. 67.9 ± 6.0, P < 0.001). The tapering regimen suppressed this rebound platelet aggregation by ADP 5 μmol/l at 2 weeks (P = 0.001) and 4 weeks (P = 0.001). Similar results were found with ADP 10 μmol/l and collagen agonists. Abrupt cessation of clopidogrel results in an early rise in platelet aggregability in patients with BMS that is attenuated by a tapering regimen. Clopidogrel administration every other day may achieve similar levels of platelet inhibition as full dose therapy. Further investigations evaluating clopidogrel tapering strategies and their potential clinical impact are warranted.

Original languageEnglish
Pages (from-to)16-21
Number of pages6
JournalJournal of Thrombosis and Thrombolysis
Issue number1
StatePublished - 1 Jan 2012
Externally publishedYes


  • Antiplatelet therapy
  • Percutaneous coronary intervention
  • Platelet function

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Clopidogrel tapering as a strategy to attenuate platelet rebound phenomenon in patients with bare-metal stents'. Together they form a unique fingerprint.

Cite this