Randomized Comparisons of Double-Dose Clopidogrel or Adjunctive Cilostazol Versus Standard Dual Antiplatelet in Patients With High Posttreatment Platelet Reactivity: Results of the CREATIVE Trial
Authors' conclusion
In patients with low responsiveness to clopidogrel, as measured by thromboelastography, the intensified antiplatelet strategies with adjunctive use of cilostazol significantly improved the clinical outcomes without increasing the risk of major bleeding. Decreased trend of negative outcomes could be observed in patients with double dosage of clopidogrel, but the difference was not significant.
Study context
- Population
- Patients undergoing PCI at high thrombotic risk (low responsiveness to clopidogrel by thromboelastography)
- Participants
- 1,078 patients
- Comparison
- Intensified antiplatelet therapy vs standard dual antiplatelet therapy
- Primary endpoint
- MACCE:
- All-cause death
- MI
- Target vessel revascularization
- Stroke
- Follow-up
- 18 months after PCI
Methodological detailssingle-centre
- Single-centre
Primary result
As reported in the abstract
Each group vs STANDARDHazard ratio (95% CI)
DOUBLE
0.720(0.474–1.094)
TRIPLE
0.550(0.349–0.866)
Safety
Major bleeding (BARC grade ≥3)
Minor bleeding (BARC-defined)
- Major bleeding (BARC grade ≥3): DOUBLE vs STANDARD P=0.133
- Major bleeding (BARC grade ≥3): TRIPLE vs STANDARD P=0.240
- Minor bleeding (BARC-defined): DOUBLE vs STANDARD P=0.031
- Minor bleeding (BARC-defined): TRIPLE vs STANDARD P=0.146
Original publication
Randomized Comparisons of Double-Dose Clopidogrel or Adjunctive Cilostazol Versus Standard Dual Antiplatelet in Patients With High Posttreatment Platelet Reactivity: Results of the CREATIVE Trial. Circulation. Published 2 February 2018. doi:10.
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