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High-maintenance-dose clopidogrel in patients undergoing percutaneous coronary intervention: a systematic review and

Yu Chen1, Yachen Zhang, Yong Tang

  • 1Division of Cardiology, Xinhua Hospital School of Medicine, Shanghai Jiaotong University, Shanghai, China.

Plos One
|November 7, 2013
PubMed

Insights

High-maintenance-dose clopidogrel significantly reduces major adverse cardiovascular events and stent thrombosis in patients after percutaneous coronary intervention. This optimized antiplatelet therapy does not increase bleeding risk, offering improved outcomes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Adverse cardiovascular events frequently recur in patients post-percutaneous coronary intervention (PCI) despite standard clopidogrel use.
  • Optimizing antiplatelet therapy is crucial for improving outcomes in this patient population.

Purpose of the Study:

  • To conduct a meta-analysis evaluating the efficacy and safety of high-dose versus standard-dose maintenance clopidogrel in patients undergoing PCI.
  • To quantify the impact of higher clopidogrel doses on ischemic events and bleeding complications.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Included RCTs compared high (>75 mg) versus standard maintenance doses of clopidogrel in PCI patients.
  • Primary endpoints included major adverse cardiovascular/cerebrovascular events (MACE/MACCE) and major bleeding; secondary endpoints assessed other ischemic and bleeding events.

Main Results:

  • 14 RCTs involving 4424 patients were analyzed.
  • High-maintenance-dose clopidogrel significantly reduced MACE/MACCE (OR 0.60), stent thrombosis (OR 0.56), and target vessel revascularization (OR 0.38).
  • No significant increase in major bleeding (OR 0.73) or any bleeding (OR 1.14) was observed, though minor bleeding risk was slightly higher (OR 1.29).

Conclusions:

  • High-maintenance-dose clopidogrel is effective in reducing recurrent ischemic events post-PCI.
  • This therapeutic strategy appears safe, without a significant increase in major bleeding complications.
Abstract

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