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Benefits of clopidogrel in patients undergoing coronary stenting significantly depend on loading dose: evidence from

Giuseppe G L Biondi-Zoccai1, Marzia Lotrionte, Pierfrancesco Agostoni

  • 1Interventional Cardiology, Division of Cardiology, University of Turin, Turin, Italy. gbiondizoccai@gmail.com

American Heart Journal
|March 27, 2007
PubMed

Insights

For patients undergoing coronary stenting, clopidogrel with an initial loading dose is superior to ticlopidine. This finding supports optimal initial dosing strategies for antiplatelet therapy after stenting.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Clopidogrel is a safer alternative to ticlopidine for patients post-coronary stenting.
  • Optimal initial dosing of clopidogrel remains unclear.

Purpose of the Study:

  • To systematically review and meta-regression analyze randomized clinical trials comparing clopidogrel and ticlopidine.
  • To evaluate the impact of clopidogrel front-loading on patient outcomes.

Main Methods:

  • Systematic review of randomized clinical trials updated to August 2006.
  • Meta-regression analysis to assess the effect of clopidogrel loading doses.

Main Results:

  • Seven trials involving 3382 patients were analyzed.
  • Clopidogrel with a loading dose showed significantly better outcomes than ticlopidine (OR 0.60, P = .05).
  • Meta-regression confirmed the significant interaction between clopidogrel loading and improved outcomes.

Conclusions:

  • A clopidogrel regimen including an initial loading dose is superior to ticlopidine.
  • This supports the use of loading doses for clopidogrel in patients undergoing coronary stenting.
Abstract

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