Effect of timing of clopidogrel administration on 30-day clinical outcomes: 300-mg loading dose immediately after coronary stenting versus pretreatment 6 to 24 hours before stenting in a large unselected patient cohort.

Full Abstract

BACKGROUND:
The aim of our prospective multicenter Clopidogrel Registry was to evaluate the efficacy and safety of a 300-mg loading dose of clopidogrel at the time of ad hoc stenting in patients with suspected coronary artery disease who were not pretreated with clopidogrel for any reason, and to compare the 30-day clinical event rates with the outcome of patients pretreated with a loading dose of clopidogrel 6 to 24 hours before stenting.

METHODS:
Between March 2002 and February 2004, 4160 consecutively included patients received a 300-mg loading dose of clopidogrel immediately after (group 1, n = 2679) or 6 to 24 hours before stenting (group 2, n = 1481).

RESULTS:
The primary end point (triple composite end point of acute myocardial infarction, all-cause death, and urgent repeat target vessel revascularization) at 30 days occurred in 4.74% versus 2.77% in groups 1 and 2, respectively (P = .002). The secondary end point events, the stent thrombosis, occurred significantly more frequently in group 1, with a trend toward increase in incidence of death, target vessel revascularization, or need for glycoprotein IIb/IIIa antagonists during percutaneous coronary intervention. Pretreatment with clopidogrel was associated with more major bleeding (secondary safety end point) (0.41% vs 1.35% in groups 1 and 2, respectively; P = .001).

CONCLUSIONS:
The results of our multicenter prospective Clopidogrel Registry demonstrate lower efficacy of a 300-mg loading dose of clopidogrel at the time of stenting compared with pretreatment 6 to 24 hours before percutaneous coronary intervention on the 30-day composite clinical end point in the large unselected patient cohort, which suggests the benefit of clopidogrel pretreatment in all incoming patients with suspected significant coronary artery disease scheduled for coronary angiography.

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Author information

Author/s: Szük, Tibor (T); Gyöngyösi, Mariann (M); Homorodi, Nóra (N); Kristóf, Eva (E); Király, Csaba (C); Edes, István F (IF); Facskó, Andrea (A); Pavo, Noemi (N); Sodeck, Gottfried (G); Strehblow, Christoph (C); Farhan, Serdar (S); Maurer, Gerald (G); Glogar, Dietmar (D); Domanovits, Hans (H); Huber, Kurt (K); Edes, István (I);

Affiliation: Department of Cardiology, Medical University of Vienna, Vienna, Austria.

Journal and publication information

Publication Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't

Journal: American heart journal (Am Heart J), published in United States. (Language: eng)

Reference: 2007-Feb; vol 153 (issue 2) : pp 289-95

Dates: Created 2007/01/22; Completed 2007/03/20; Revised 2007/11/15;

PMID: 17239691, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Expert Opin Pharmacother. 2007 Jun;8(9):1399-402. (PMID: 17563272)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Combined Modality Therapy
Coronary Artery Disease - drug therapy; surgery
Drug Administration Schedule
Female
Humans
Male
Middle Aged
Myocardial Revascularization

Platelet Aggregation Inhibitors - administration & dosage
Preoperative Care
Prospective Studies
Registries
Stents
Ticlopidine - administration & dosage; analogs & derivatives
Time Factors
Treatment Outcome

Associated Chemicals: Platelet Aggregation Inhibitors (0) ; Ticlopidine (55142-85-3) ; clopidogrel (90055-48-4)

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