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Extracardiac vascular disease and effectiveness of sustained clopidogrel treatment
D Mukherjee1, E J Topol, D J Moliterno
1Division of Cardiovascular Medicine, The Gill Heart Institute, Lexington, Kentucky 40536-0200, USA. Mukherjee@uky.edu
Insights
Long-term clopidogrel treatment significantly reduces thrombotic events in patients with extracardiac vascular disease (ECVD). This therapy offers enhanced protection, particularly for those with diffuse atherosclerosis.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Clinical Trials
Background:
- Extracardiac vascular disease (ECVD) encompasses peripheral arterial disease and cerebrovascular disease.
- Patients with ECVD often have diffuse atherosclerosis, increasing thrombotic event risk.
- Clopidogrel is an antiplatelet medication used to prevent thrombotic events.
Purpose of the Study:
- To evaluate the long-term effectiveness of clopidogrel in patients with ECVD.
- To determine if clopidogrel provides additional protection beyond coronary arteries.
Main Methods:
- Subgroup analysis of the prospective, randomized, double-blind, placebo-controlled CREDO trial.
- Included 272 patients with ECVD from a larger trial of 2116 patients undergoing or likely to undergo coronary intervention.
- Assessed one-year incidence of death, myocardial infarction, or stroke.
Main Results:
- Patients with ECVD experienced a greater than twofold relative risk reduction for the primary endpoint with clopidogrel (47.9%) compared to those without ECVD (18.2%).
- The 95% confidence intervals indicated a significant benefit in the ECVD subgroup.
Conclusions:
- Long-term clopidogrel treatment offers significant protection against thrombotic events in the entire arterial vasculature.
- Clopidogrel may be particularly beneficial for patients with ECVD and diffuse atherosclerosis.
Objective:
To assess the effectiveness of long term treatment with clopidogrel of patients with extracardiac vascular disease (ECVD) (a history of either peripheral arterial disease or cerebrovascular disease).
Design:
Subgroup analysis of a prospective randomised clinical trial.
Setting:
The CREDO (clopidogrel for the reduction of events during observation) trial was a randomised, double blind, placebo controlled trial conducted at 99 centres in North America from June 1999 through April 2001.
Patients:
2116 patients who were to undergo elective coronary intervention or were deemed at high likelihood of undergoing percutaneous coronary intervention were enrolled in the CREDO trial. The current study sample consisted of 272 patients with ECVD.
Main Outcome Measure:
One year incidence of the composite of death, myocardial infarction, or stroke in the intent to treat population.
Results:
Patients with ECVD had a more than twofold greater relative risk reduction with clopidogrel for the primary end point compared with patients without ECVD (47.9%, 95% confidence interval (CI) -4.2% to 73.9%, v 18.2%, 95% CI -10.5 % to 39.5%, respectively).
Conclusions:
Longer term clopidogrel treatment provides added protection against thrombotic events throughout the arterial vasculature, not limited to the coronary arteries, and may be especially effective for patients with more diffuse atherosclerosis such as ECVD.
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