Triflusal is a derivative of
acetylsalicylic acid but it exhibits different pharmacological and pharmacokinetic properties. The object of this study was to evaluate the efficacy of additional use of
triflusal in patients who underwent
drug-eluting stent implantation. First, we prospectively tested platelet function with a rapid platelet function analyzer (VerifyNow-
Aspirin) in patients with
stable angina (male, age, 61.6 +/- 8.3,
body weight, 69.3 +/- 11.2 kg) who maintained dual (
aspirin 100 mg and
clopidogrel 75 mg per day, n = 23) or triple (
aspirin 100 mg,
clopidogrel 75 mg, and
triflusal 300 mg per day, n = 23)
therapy for more than one month. They were randomly assigned to a group. The triple group showed superior inhibition of
arachidonic acid induced platelet aggregation compared to the dual group (420.2 +/- 47.7 ARU versus 465.0 +/- 71.2 ARU, P = 0.016). Second, we compared composite outcomes (death,
myocardial infarction, and nonhemorrhagic
stroke) after
drug-eluting stent (DES) implantation between the dual (n = 1474) and triple (n = 433) groups in the prospective Seoul National University Hospital
drug-eluting stent (SNUH-DES) cohort. The triple group had more current smokers, male patients, and patients with a previous history of revascularization. Also, the triple group underwent more complex interventions such as left main, chronic total occlusion, long lesion, and restenotic lesion than the dual group. In spite of their higher risk profiles, the triple group patients showed comparable composite outcomes (19 cases, 4.4%) to those of the dual group ones (41 cases, 2.8%) (P = 0.12). The
triflusal-based triple antiplatelet
therapy achieved superior platelet inhibition compared to the dual
therapy ex vivo and it could be applied after complex intervention with DES.