Clopidogrel pretreatment in PCI: absolute requirement or obsolete myth?

Area of Science:

• Cardiology
• Pharmacology
• Interventional Cardiology

Background:

• Clopidogrel loading is crucial before percutaneous coronary intervention (PCI).
• Optimal dosing, timing, and patient selection for clopidogrel loading are debated.
• The role of adjunctive therapies and managing clopidogrel resistance requires clarification.

Purpose of the Study:

• To review current uncertainties surrounding clopidogrel loading strategies before PCI.
• To discuss optimal loading dose, timing, and patient selection.
• To explore the impact of adjunctive therapies and clopidogrel resistance.

Main Methods:

• Review of recent clinical experience and existing literature.
• Discussion of unresolved questions regarding clopidogrel administration protocols.
• Analysis of periprocedural event rates in different loading strategies.

Main Results:

• Recent data indicate no increased periprocedural events with immediate PCI post-loading versus delayed PCI.
• Optimal loading dose, timing, and selective vs. non-selective loading remain areas of active investigation.
• The efficacy of adjunctive GPIIb/IIIa antagonists or bivalirudin and strategies for clopidogrel resistance need further study.

Conclusions:

• The optimal clopidogrel loading strategy before PCI requires further research.
• Immediate PCI after high-dose loading appears safe regarding periprocedural events.
• Addressing clopidogrel resistance and tailoring protocols for different patient groups are critical.