Emerging Data Regarding the Potential Benefits of Early Initiation of Clopidogrel Among ACS Patients
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Emerging Data Regarding the Potential Benefits of Early Initiation of Clopidogrel Among ACS Patients. C. Michael Gibson, M.S., M.D. Inhibition of Platelet Aggregation Following Clopidogrel Administration. Hochholzer W et al. Circulation. 2005;111. Clopidogrel.

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Emerging Data Regarding the Potential Benefits of Early Initiation of Clopidogrel Among ACS Patients

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Emerging Data Regarding the Potential Benefits of Early Initiation of Clopidogrel Among ACS Patients

C. Michael Gibson, M.S., M.D.


Inhibition of Platelet Aggregation Following Clopidogrel Administration

Hochholzer W et al. Circulation. 2005;111


Clopidogrel

Clopidogrel Loading Dose Timing and Risk of MACE

Log Odds of Death, MI

or UTVR at 28 Days

Placebo

- 2

P = 0.020

for treatment / timing

interaction

- 3

- 4

- 5

- 6

0

5

10

15

20

25

30

Hours Prior to PCI of Study Drug Loading Dose

J Am Coll Cardiol 2006;47:939–43.


Influence of Thienopyridine Exposure – PCI pts

30 Day Primary Endpoint Adverse Events

RR [95%CI]

0.81 (0.68-0.96)

RR [95%CI]

0.96 (0.77-1.20)

RR [95%CI]

0.50 (0.37-0.67)

RR [95%CI]

1.07 (0.83-1.39)

RR [95%CI]

1.37 (1.00-1.88)

RR [95%CI]

0.61 (0.39-0.97)

Thienopyridine Exposed

Not Thienopyridine Exposed


Clopidogrel stopped

<5 days

prior to CABG

Clopidogrel stopped

>5 days

prior to CABG

CURE: Major Bleeding in CABG Patients

  • Major or life-threatening bleeding w/in 7 days of CABG

P=0.07

P=0.53

K.Fox et al, ESC 2002


ACUITY: Primary Outcomes in CABG Patients

  • Patients with and without a thienopyridine administered in-hospital prior to CABG

P=0.066

P=0.013

P=0.362

*Heparin=unfractionated or enoxaparin


30 Day Outcomes – CABG Patients by Thienopyridine Status

  • Patients with and without a thienopyridine administered in-hospital prior to CABG


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