Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

“…20 In PCI-CURE, 21 a prospective subgroup analysis of 2,658 patients from the CURE study who underwent PCI with a bare-metal stent, a 31% relative reduction in the composite end point was reported with clopidogrel plus aspirin compared with aspirin alone (8.8% vs 12.6%; P = 0.002). In the CREDO trial, 22 which involved 2,116 patients undergoing elective PCI, the benefits of a preprocedural loading dose of clopidogrel, and of continuing clopidogrel for 12 months after PCI with a bare-metal stent, both in addition to aspirin therapy, were investigated. Treatment with clopidogrel in addition to aspirin for 12 months after PCI was associated with a 26.9% relative reduction in the composite end point of death, MI, and stroke compared with aspirin alone (8.5% vs 11.5%; P = 0.02).…”

“…Treatment with clopidogrel in addition to aspirin for 12 months after PCI was associated with a 26.9% relative reduction in the composite end point of death, MI, and stroke compared with aspirin alone (8.5% vs 11.5%; P = 0.02). 22 A subgroup analysis of the timing of the preprocedural loading dose suggested that clopidogrel 300 mg should be given ≥6 h, and ideally ≥15 h, before PCI. 23 In the COMMIT trial 24 of Chinese patients with suspected acute MI, short-term (in-hospital for up to 4 weeks) treatment with clopidogrel resulted in a 9% reduction in the composite ischaemic end point (P = 0.002), and a 7% reduction in all-cause mortality (P = 0.03).…”

SCAI statement on ad hoc versus the separate performance of diagnostic cardiac catheterization and coronary intervention

“…Potential risks include interim myocardial infarction [20] and increased bleeding if bypass surgery is performed within the next 5 days. However, in high-risk patients, clopidogrel given several hours before intervention may decrease the risk of procedure-related myocardial infarction [31][32][33]. In low-risk patients, clopidogrel given several hours before the procedure may obviate the need for glycoprotein IIb/IIIa inhibitors and their attendant small risks of bleeding or thrombocytopenia [34].…”

“…When the possibility of PCI is high, pretreatment with clopidogrel may be appropriate before diagnostic angiography [20,[31][32][33][34], although this may delay subsequent cardiac surgery if that is deemed necessary. Adequate hydration and perhaps acetylcysteine in patients with renal insufficiency are important because of the greater dye load anticipated [28].…”

Contemporary issues on clopidogrel therapy: a critical appraisal

“…Following the results of the pivotal Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE) trial [1], it received approval from the Food and Drug Administration in 1997 and Conformité Européenne in 1998. Subsequent studies extend on the indications for its use in the setting of acute coronary syndromes (ACS) [2], ST-segment elevation myocardial infarction [3,4] and percutaneous coronary intervention (PCI) [5,6]. Despite the robust clinical findings and indications for clopidogrel usage derived from these large-scale clinical trials performed over the course of the past decade, which are clearly reflected in clinical practice guidelines [7][8][9], there are a large number of uncertainties regarding clopidogrel usage in daily real world practice.…”