Clopidogrel bisulfate: in ST-segment elevation myocardial infarction
Jennifer S Dickie1, Lesley J Scott
1Wolters Kluwer Health, Adis, Auckland, New Zealand. demail@adis.co.nz
Insights
Clopidogrel plus aspirin significantly reduces major adverse events in ST-segment elevation myocardial infarction (STEMI) patients. This combination therapy is well-tolerated and associated with fewer deaths, reinfarctions, or strokes.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Clopidogrel is an antiplatelet medication used to prevent atherothrombotic events.
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring prompt treatment to reduce mortality and morbidity.
Purpose of the Study:
- To evaluate the efficacy and safety of clopidogrel in combination with aspirin for STEMI patients.
- To assess the impact of clopidogrel on reducing major adverse cardiovascular events and mortality in STEMI.
Main Methods:
- Analysis of data from two large clinical trials: COMMIT/CCS-2 (45,852 patients) and CLARITY-TIMI 28 (3,491 patients).
- Comparison of clopidogrel plus aspirin versus aspirin alone or aspirin plus placebo in STEMI patients.
Main Results:
- Clopidogrel plus aspirin significantly reduced the composite endpoint of reinfarction, stroke, or death from any cause in STEMI patients.
- Treatment with clopidogrel 75 mg/day plus aspirin for approximately two weeks prevented nine major adverse events per 1000 patients treated.
- No significant difference in major bleeding rates was observed between clopidogrel plus aspirin and control groups.
Conclusions:
- Clopidogrel in combination with aspirin is effective in reducing atherothrombotic events in STEMI patients.
- The combination therapy is generally well-tolerated, with a favorable safety profile regarding major bleeding.
- Longer-term clopidogrel monotherapy has also shown good tolerability in other patient populations.
Abstract:
Clopidogrel bisulfate (hereafter, clopidogrel), a selective inhibitor of ADP-induced platelet aggregation, is approved for the reduction of atherothrombotic events in patients with ST-segment elevation myocardial infarction (STEMI). In COMMIT/CCS-2, a well designed trial in 45,852 adult patients with STEMI, relative to aspirin alone, clopidogrel 75 mg/day plus aspirin treatment significantly reduced the risk of both coprimary endpoints: the composite endpoint of reinfarction, stroke, or death from any cause and the risk of death from any cause. Based on the findings of this trial, treating 1000 patients for approximately 2 weeks with clopidogrel is associated with nine fewer patient deaths, reinfarctions, or strokes during treatment. In CLARITY-TIMI 28, a well designed supportive study in 3491 adult patients with STEMI, clopidogrel plus aspirin reduced the odds that a composite primary endpoint event of an occluded infarct-related artery, recurrent myocardial infarction, or death from any cause would occur versus aspirin plus placebo. Clopidogrel treatment was generally well tolerated in these clinical trials, with no significant between-group difference in the rate of major bleeding in either trial. Experience in other patient populations (e.g. those with recent myocardial infarction, recent ischemic stroke, or established peripheral arterial disease) has shown that longer-term (< or =3 years) clopidogrel monotherapy is generally well tolerated.
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