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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
10:28

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Clopidogrel loading doses and outcomes of patients undergoing percutaneous coronary intervention for acute coronary

Cheng Wang1, Dean J Kereiakes, Jay P Bae

  • 1Solucient Inc. Thomson Healthcare, Montvale, New Jersey 07645, USA. brian.griffin@thomson.com

The Journal of Invasive Cardiology
|October 2, 2007
PubMed

Insights

Higher clopidogrel loading doses for acute coronary syndromes (ACS) patients undergoing percutaneous coronary intervention (PCI) did not improve outcomes. This retrospective analysis found no additional clinical benefit, with higher myocardial infarction rates in the high-dose group.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Increasing use of higher clopidogrel loading doses in percutaneous coronary intervention (PCI) lacks robust clinical evidence.
  • Standard clopidogrel loading dose is 300 mg.

Purpose of the Study:

  • To evaluate the clinical benefit of higher-than-standard clopidogrel loading doses in acute coronary syndromes (ACS) patients undergoing PCI.
  • To compare outcomes between standard and high-dose clopidogrel loading strategies.

Main Methods:

  • Retrospective analysis of 2,484 ACS patients undergoing PCI.
  • Comparison of outcomes between standard (300 mg) and high-dose (>300 mg) clopidogrel loading groups.
  • Propensity score analysis to adjust for clinical risk differences.

Main Results:

  • Higher clopidogrel loading doses were associated with a significantly higher rate of the combined endpoint (myocardial infarction, stroke, revascularization, death) at 60 days (37.1% vs. 20.5%).
  • Myocardial infarction rates were substantially higher in the high-dose group (34.7% vs. 17.3%).
  • No significant difference in bleeding event rates was observed between the groups.

Conclusions:

  • Higher clopidogrel loading doses (>300 mg) are not associated with additional clinical benefit in ACS patients undergoing PCI.
  • Current clinical practice of using higher loading doses may not be supported by evidence.
  • Further research may be needed to define optimal clopidogrel dosing strategies.
Abstract

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