Randomized comparison of ticlopidine and clopidogrel after intracoronary stent implantation in a broad patient
M Taniuchi1, H I Kurz, J M Lasala
1Department of Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO 63110, USA. mtaniuch@imgate.wustl.edu
Insights
Clopidogrel and ticlopidine showed similar efficacy in preventing stent thrombosis after coronary stent implantation. Clopidogrel was better tolerated than ticlopidine over a 2-week period.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Interventional Cardiology
Background:
- Subacute stent thrombosis is a risk following intracoronary stent implantation.
- Clopidogrel is utilized for prevention, but direct randomized comparisons with ticlopidine in the US were lacking.
Purpose of the Study:
- To compare the safety and efficacy of clopidogrel versus ticlopidine in preventing subacute stent thrombosis.
- To evaluate major adverse cardiac events in patients receiving intracoronary stents.
Main Methods:
- A randomized trial involving 1016 patients undergoing successful intracoronary stent implantation.
- Patients received either ticlopidine or clopidogrel for 2 weeks post-procedure.
- Data collected included therapy completion rates, stent thrombosis, and major adverse cardiac events within 30 days.
Main Results:
- Therapy completion was higher with clopidogrel (98.38%) compared to ticlopidine (96.36%) (P=0.043).
- Stent thrombosis occurred in 2.02% of the clopidogrel group and 1.92% of the ticlopidine group (P=0.901).
- Major adverse cardiac events were similar: 3.85% for clopidogrel and 4.60% for ticlopidine (P=0.551).
Conclusions:
- Clopidogrel is better tolerated than ticlopidine for a 2-week regimen post-stent implantation.
- Both agents, when combined with glycoprotein IIb/IIIa inhibitors, demonstrated safety.
- Clopidogrel offers comparable protection against subacute stent thrombosis and major adverse cardiac events as ticlopidine.
Background:
Although clopidogrel is used to prevent subacute stent thrombosis, its safety and efficacy have not been compared with ticlopidine in a randomized manner in the United States.
Methods And Results:
Patients with successful intracoronary stent implantation were randomly assigned to therapy with ticlopidine or clopidogrel. Loading doses were administered immediately after the procedure, and the drugs were prescribed for 2 weeks. One thousand sixteen patients were enrolled: 522 patients were randomly assigned to ticlopidine therapy and 494 to clopidogrel. High-risk characteristics included recent myocardial infarction in 41.4% of the cases, angiographically evident thrombus in 20.9%, and abrupt or threatened closure in 3.64%. An intravenous glycoprotein IIb/IIIa inhibitor was used in 48.2% of the cases, and thrombocytopenia occurred in 1.43% of these patients. Failure to complete 2 weeks of therapy occurred in 3.64% of the patients treated with ticlopidine and in 1.62% of the patients treated with clopidogrel (P=0.043). Within 30 days, thrombosis of the stent occurred in 1.92% of the patients in the ticlopidine group and in 2.02% of the clopidogrel group (P=0.901). A major adverse cardiac event occurred in 4.60% of patients receiving ticlopidine and in 3.85% of patients receiving clopidogrel (P=0.551).
Conclusions:
Clopidogrel is better tolerated than ticlopidine during a 2-week regimen after intracoronary stent implantation. Combining either thienopyridine with an intravenous platelet IIb/IIIa inhibitor appears to be safe. When applied to a broad spectrum of patients receiving stent implantation, clopidogrel confers similar protection as ticlopidine against subacute stent thrombosis and major adverse cardiac events.
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