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

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


Inhibition of platelet aggregation following clopidogrel administration
Inhibition of Platelet Aggregation Following Clopidogrel Administration

Hochholzer W et al. Circulation. 2005;111


Clopidogrel Administration

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 Administration

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


Cure major bleeding in cabg patients

Clopidogrel stopped Administration

<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
ACUITY: Primary Outcomes in CABG Patients Administration

  • 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
30 Day Outcomes – CABG Patients by Thienopyridine Status Administration

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


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