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Clopidogrel therapy in patients undergoing coronary stenting: value of a high-loading-dose regimen
Jürgen Pache1, Adnan Kastrati, Julinda Mehilli
1Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Technische Universität, Munich, Germany. pache@dhm.mhn.de
Insights
High-loading-dose clopidogrel before stenting reduced adverse events by 35% compared to ticlopidine. This regimen is safe and improves clinical outcomes in patients undergoing coronary artery stenting.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary artery stenting requires effective antiplatelet therapy to prevent adverse events.
- Conventional ticlopidine therapy has limitations and potential side effects.
Purpose of the Study:
- To evaluate the clinical value of a high loading dose of clopidogrel administered before coronary stent placement.
- To compare the efficacy and safety of this regimen against conventional ticlopidine therapy.
Main Methods:
- A comparative study involving 864 patients receiving high-loading-dose clopidogrel (600 mg pre-procedure) and 870 patients on ticlopidine.
- Assessment of a composite endpoint including death, myocardial infarction, or urgent revascularization.
- Analysis of outcomes irrespective of periprocedural abciximab use (in 62% of patients).
Main Results:
- The clopidogrel group experienced significantly fewer adverse events (4.5%) compared to the ticlopidine group (6.8%).
- Clopidogrel therapy demonstrated a 35% reduction in the risk of early adverse events (OR 0.65; 95% CI, 0.43-0.98).
Conclusions:
- A high-loading-dose clopidogrel regimen initiated before coronary stenting is safe.
- This regimen leads to more favorable clinical outcomes than conventional ticlopidine therapy.
Abstract:
The objective of this study was to assess the value of a clopidogrel regimen based on a high loading dose initiated before the stent placement procedure. A consecutive series of 864 patients treated with a high-loading-dose clopidogrel regimen (600 mg given 2-4 hr prior to intervention) was compared with 870 patients treated with conventional ticlopidine therapy. Abciximab was given periprocedurally in 62% of the patients. The composite endpoint of death, myocardial infarction, or urgent revascularization was reached by 39 (4.5%) clopidogrel patients and 59 (6.8%) ticlopidine patients. Clopidogrel therapy was associated with a 35% reduction of the risk for early adverse events (odds ratio 0.65; 95% confidence interval, 0.43-0.98). Thus, a high-loading-dose clopidogrel regimen in patients undergoing coronary artery stenting was safe and led to a more favorable clinical outcome than conventional therapy with ticlopidine regardless of concomitant treatment with abciximab.