Timing of clopidogrel loading before percutaneous coronary intervention in clopidogrel-naive patients with stable or unstable angina: A comparison of two strategies

Pretreatment with P2Y 12 Inhibitors in Non–ST-Segment–Elevation Acute Coronary Syndrome: An Outdated and Harmful Strategy

“…However, this benefit was driven mainly by periprocedural myocardial infarction, a controversial end point. Of importance, similar trends were observed in elective PCI in that 15% to 40% of NSTE-ACS patients were stabilized [27][28][29] ( Figure 2B). One may argue that the lack of mortality benefit in this patient subset is a concern.…”

Effectiveness of Pretreatment With Dual Oral Antiplatelet Therapy

“…On the other hand, in patients with stable CAD who are scheduled for PCI, the pathophysiology of disease is completely different, CV risk is low, and peri-procedural ischemic events are much less frequent than in ACS. Indeed, most studies on pre-treatment of stable CAD patients have failed to show a clear signal of benefit (10,(15)(16)(17)(18)(19)(20)(21)(22)(23) (Table 1). Consistently, the most recent guidelines issued by the…”

Clopidogrel pretreatment in PCI: Absolute requirement or obsolete myth?

“…Post-PCI hsCRP levels significantly decreased with the addition of eptifibatide, implying that antiplatelet therapy with clopidogrel alone was not sufficient to overcome the inflammatory response. In the ARMYDA-2 study, hsCRP levels also increased post-PCI with no difference in the 24 h levels between patients loaded 4-8 h before PCI with 300 vs 600 mg of clopidogrel [14], while a similar increase was described in clopidogrel naive patients loaded with 900 mg of clopidogrel and undergoing PCI either immediately or 2 h later [26]. Therefore, although clopidogrel pretreatment reduces hsCRP post-PCI compared to no pretreatment, it does not seem to be any further benefit with higher loading dose, or with administration of the loading dose 2-8 h before the procedure.…”

“…unstable patients) without however direct evidence that delaying PCI for 2 h -as suggested by the guidelines -is not necessary and that ad hoc PCI is safe. The strategy of 2 h delay in performing PCI after loading with the patient monitored in the recovery room of the catheterization laboratory was tested recently by our group [26], where we found no difference in clinical end points at 30 days between delaying PCI for 2 h vs immediate PCI after loading. Studies with outcome of PCI patients loaded in the catheterization laboratory immediately prior to intervention are shown in Table 2.…”