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Clopidogrel Loading Dose (300 Versus 600 mg) Strategies for Patients With Stable Angina Pectoris Subjected to Percutaneous Coronary Intervention

Published:February 14, 2006DOI:https://doi.org/10.1016/j.amjcard.2005.10.064
      We evaluated the effect of high versus low loading doses of clopidogrel in patients with stable angina pectoris who underwent percutaneous coronary intervention (PCI) on periprocedural events, in-hospital complications, and 30-day outcomes. The recommended loading dose of clopidogrel for patients with PCI is currently 300 mg. Recent studies have suggested that 600 mg may decrease periprocedural complications in patients with unstable angina. However, whether this holds for patients with stable angina pectoris is unknown. We reviewed records of 445 patients with stable angina pectoris who underwent PCI and were loaded with 300 mg (n = 126) or 600 mg (n = 319) of clopidogrel immediately before the procedure. Study end points were periprocedural ischemic events, bleeding complications, and a composite of major adverse cardiac events at 30 days. Baseline characteristics and procedural indexes were similar between groups. Major in-hospital complications were recorded in 2 patients in the 600-mg group and in no patient in the 300-mg group (p = 1.00). Postprocedural increase of cardiac enzymes (troponin I, p = 0.91; creatinine kinase-MB, p = 0.395) and major bleeding (0.6% vs 0%, p = 1.00) were comparable, as was 30-day major adverse cardiac events (1.2% vs 0%, p = 0.56). Multivariate analysis did not identify any risk decrease for periprocedural myocardial infarction with 600 mg of clopidogrel (odds ratio 2.68, 95% confidence interval 0.74 to 9.78, p = 0.135). In conclusion, in patients with stable angina pectoris, a 300-mg clopidogrel loading dose, when given immediately before PCI, is sufficient. Although 600 mg was clinically safe, it was not associated with fewer periprocedural events and improved 30-day outcomes compared with 300 mg.
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      References

        • van der Heijden D.J.
        • Westendorp I.C.
        • Riezebos R.K.
        • Kiemeneij F.
        • Slagboom T.
        • van der Wieken L.R.
        • Laarman G.J.
        Lack of efficacy of clopidogrel pre-treatment in the prevention of myocardial damage after elective stent implantation.
        J Am Coll Cardiol. 2004; 44: 20-24
        • Kastrati A.
        • von Beckerath N.
        • Joost A.
        • Pogatsa-Murray G.
        • Gorchakova O.
        • Schomig A.
        Loading with 600 mg clopidogrel in patients with coronary artery disease with and without chronic clopidogrel therapy.
        Circulation. 2004; 110: 1916-1919
        • Kastrati A.
        • Mehilli J.
        • Schuhlen H.
        • Dirschinger J.
        • Dotzer F.
        • ten Berg J.M.
        • Neumann F.J.
        • Bollwein H.
        • Volmer C.
        • Gawaz M.
        • et al.
        A clinical trial of abciximab in elective percutaneous coronary intervention after pretreatment with clopidogrel.
        N Engl J Med. 2004; 350: 232-238
        • Mehta S.R.
        • Yusuf S.
        • Peters R.J.
        • Bertrand M.E.
        • Lewis B.S.
        • Natarajan M.K.
        • Malmberg K.
        • Rupprecht H.
        • Zhao F.
        • Chrolavicius S.
        • et al.
        Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention.
        Lancet. 2001; 358: 527-533
        • Cannon C.
        Clopidogrel and percutaneous coronary intervention.
        Lancet. 2002; 359: 169
        • Stables R.H.
        Clopidogrel in invasive management of non-ST-elevation ACS.
        Lancet. 2001; 358: 520-521
        • Steinhubl S.R.
        • Lauer M.S.
        • Mukherjee D.P.
        • Moliterno D.J.
        • Lincoff A.M.
        • Ellis S.G.
        • Topol E.J.
        The duration of pretreatment with ticlopidine prior to stenting is associated with the risk of procedure-related non–Q-wave myocardial infarctions.
        J Am Coll Cardiol. 1998; 32: 1366-1370
        • Mann T.
        • Cubeddu R.J.
        • Raynor L.
        • Bowen J.
        • Schneider J.E.
        • Rose G.
        • Cubeddu G.
        • Raza J.A.
        • Jobe R.L.
        • Newman W.
        • Zellinger M.
        Coronary stenting in stable patients.
        Catheter Cardiovasc Interv. 2003; 58: 459-466
        • Patti G.
        • Colonna G.
        • Pasceri V.
        • Pepe L.L.
        • Montinaro A.
        • Di Sciascio G.
        Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention.
        Circulation. 2005; 111: 2099-2106
        • Kandzari D.E.
        • Berger P.B.
        • Kastrati A.
        • Steinhubl S.R.
        • Mehilli J.
        • Dotzer F.
        • Ten Berg J.M.
        • Neumann F.J.
        • Bollwein H.
        • Dirschinger J.
        • Schomig A.
        Influence of treatment duration with a 600-mg dose of clopidogrel before percutaneous coronary revascularization.
        J Am Coll Cardiol. 2004; 44: 2133-2136
        • Gurbel P.A.
        • Bliden K.P.
        • Hayes K.M.
        • Yoho J.A.
        • Herzog W.R.
        • Tantry U.S.
        The relation of dosing to clopidogrel responsiveness and the incidence of high post-treatment platelet aggregation in patients undergoing coronary stenting.
        J Am Coll Cardiol. 2005; 45: 1392-1396
        • Gurbel P.A.
        • Bliden K.P.
        • Hiatt B.L.
        • O’Connor C.M.
        Clopidogrel for coronary stenting.
        Circulation. 2003; 107: 2908-2913
        • Gurbel P.A.
        • Bliden K.P.
        • Zaman K.A.
        • Yoho J.A.
        • Hayes K.M.
        • Tantry U.S.
        Clopidogrel loading with eptifibatide to arrest the reactivity of platelets.
        Circulation. 2005; 111: 1153-1159
        • Gurbel P.A.
        • Cummings C.C.
        • Bell C.R.
        • Alford A.B.
        • Meister A.F.
        • Serebruany V.L.
        Onset and extent of platelet inhibition by clopidogrel loading in patients undergoing elective coronary stenting.
        Am Heart J. 2003; 145: 239-247
        • Gurbel P.A.
        • Samara W.M.
        • Bliden K.P.
        Failure of clopidogrel to reduce platelet reactivity and activation following standard dosing in elective stenting.
        Platelets. 2004; 15: 95-99
        • Hochholzer W.
        • Trenk D.
        • Frundi D.
        • Blanke P.
        • Fischer B.
        • Andris K.
        • Bestehorn H.P.
        • Buttner H.J.
        • Neumann F.J.
        Time dependence of platelet inhibition after a 600-mg loading dose of clopidogrel in a large, unselected cohort of candidates for percutaneous coronary intervention.
        Circulation. 2005; 111: 2560-2564
        • Steinhubl S.R.
        • Berger P.B.
        • Mann III, J.T.
        • Fry E.T.
        • DeLago A.
        • Wilmer C.
        • Topol E.J.
        Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention.
        JAMA. 2002; 288: 2411-2420
        • Jaremo P.
        • Lindahl T.L.
        • Fransson S.G.
        • Richter A.
        Individual variations of platelet inhibition after loading doses of clopidogrel.
        J Intern Med. 2002; 252: 233-238
        • Muller I.
        • Besta F.
        • Schulz C.
        • Massberg S.
        • Schonig A.
        • Gawaz M.
        Prevalence of clopidogrel non-responders among patients with stable angina pectoris scheduled for elective coronary stent placement.
        Thromb Haemost. 2003; 89: 783-787
        • Matetzky S.
        • Shenkman B.
        • Guetta V.
        • Shechter M.
        • Bienart R.
        • Goldenberg I.
        • Novikov I.
        • Pres H.
        • Savion N.
        • Varon D.
        • Hod H.
        Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction.
        Circulation. 2004; 109: 3171-3175