[Clopidogrel in acute coronary syndromes with non-ST elevation. Clinical implications of the CURE trial]

The pivotal role of the platelets in the genesis of acute coronary syndromes emphasises the importance of an early and sustained antiplatelet therapy. The CURE trial shows that clopidogrel in addition to aspirin achieves this double goal, with a 20% relative risk reduction in the primary composite endpoint of cardiovascular death, myocardial infarction or stroke in the first 30 days. The benefits are apparent as early as the first 24 hours of starting the treatment. There is also a consistent benefit of clopidogrel across all groups, including both high-risk and low-risk patients, which overrides an excess of 6 out of a thousand cases treated per year of bleeds, which require transfusion. Several clinical implications of the CURE trial are analyzed: the kind of patients who benefit more on clopidogrel, how long should treatment with clopidogrel continue, cost-benefit consideration, the impact of the findings on the benefit of the use of clopidogrel, on the use of glycoprotein IIb/IIIa receptor antagonists, clopidogrel pretreatment and long term therapy in patients undergoing percutaneous coronary intervention and bleeding risk with surgery.