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

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 com...

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Published in:The American heart journal 2007-02, Vol.153 (2), p.289-295
Main Authors: Szük, Tibor, MD, Gyöngyösi, Mariann, MD, Homorodi, Nóra, MD, Kristóf, Èva, MD, Király, Csaba, MD, Èdes, István F., MD, Facskó, Andrea, MD, Pavo, Noemi, Sodeck, Gottfried, MD, Strehblow, Christoph, MD, Farhan, Serdar, MD, Maurer, Gerald, MD, FACC, Glogar, Dietmar, MD, FESC, Domanovits, Hans, MD, Huber, Kurt, MD, FESC, FACC, Èdes, István, MD
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cardiology. Vascular system
Cardiovascular
Combined Modality Therapy
Coronary Artery Disease - drug therapy
Coronary Artery Disease - surgery
Coronary heart disease
Coronary vessels
Diseases of the cardiovascular system
Drug Administration Schedule
Drug therapy
Emergency medical care
Female
Heart
Heart attacks
Humans
Male
Medical sciences
Middle Aged
Myocardial Revascularization
Platelet Aggregation Inhibitors - administration & dosage
Preoperative Care
Prospective Studies
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Registries
Stents
Ticlopidine - administration & dosage
Ticlopidine - analogs & derivatives
Time Factors
Treatment Outcome
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Summary: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.
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2006.10.030