Effect of timing of clopidogrel administration on 30-day clinical outcomes

300-mg loading dose immediately after coronary stenting versus pretreatment 6 to 24 hours before stenting in a large unselected patient cohort

Tibor Szük, Mariann Gyöngyösi, Nóra Homorodi, Èva Kristóf, Csaba Király, István F. Èdes, Andrea Facskó, Noemi Pavo, Gottfried Sodeck, Christoph Strehblow, Serdar Farhan, Gerald Maurer, Dietmar Glogar, Hans Domanovits, Kurt Huber, I. Édes

Research output: Contribution to journalArticle

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Abstract

Background: The aim of our prospective multicenter Clopidogrel Registry was to evaluate the efficacy and safety of a 300-mg loading dose of clopidogrel at the time of ad hoc stenting in patients with suspected coronary artery disease who were not pretreated with clopidogrel for any reason, and to compare the 30-day clinical event rates with the outcome of patients pretreated with a loading dose of clopidogrel 6 to 24 hours before stenting. Methods: Between March 2002 and February 2004, 4160 consecutively included patients received a 300-mg loading dose of clopidogrel immediately after (group 1, n = 2679) or 6 to 24 hours before stenting (group 2, n = 1481). Results: The primary end point (triple composite end point of acute myocardial infarction, all-cause death, and urgent repeat target vessel revascularization) at 30 days occurred in 4.74% versus 2.77% in groups 1 and 2, respectively (P = .002). The secondary end point events, the stent thrombosis, occurred significantly more frequently in group 1, with a trend toward increase in incidence of death, target vessel revascularization, or need for glycoprotein IIb/IIIa antagonists during percutaneous coronary intervention. Pretreatment with clopidogrel was associated with more major bleeding (secondary safety end point) (0.41% vs 1.35% in groups 1 and 2, respectively; P = .001). Conclusions: The results of our multicenter prospective Clopidogrel Registry demonstrate lower efficacy of a 300-mg loading dose of clopidogrel at the time of stenting compared with pretreatment 6 to 24 hours before percutaneous coronary intervention on the 30-day composite clinical end point in the large unselected patient cohort, which suggests the benefit of clopidogrel pretreatment in all incoming patients with suspected significant coronary artery disease scheduled for coronary angiography.

Original languageEnglish
Pages (from-to)289-295
Number of pages7
JournalAmerican Heart Journal
Volume153
Issue number2
DOIs
Publication statusPublished - Feb 2007

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clopidogrel
Percutaneous Coronary Intervention
Registries
Coronary Artery Disease
Safety
Platelet Glycoprotein GPIIb-IIIa Complex

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Effect of timing of clopidogrel administration on 30-day clinical outcomes : 300-mg loading dose immediately after coronary stenting versus pretreatment 6 to 24 hours before stenting in a large unselected patient cohort. / Szük, Tibor; Gyöngyösi, Mariann; Homorodi, Nóra; Kristóf, Èva; Király, Csaba; Èdes, István F.; Facskó, Andrea; Pavo, Noemi; Sodeck, Gottfried; Strehblow, Christoph; Farhan, Serdar; Maurer, Gerald; Glogar, Dietmar; Domanovits, Hans; Huber, Kurt; Édes, I.

In: American Heart Journal, Vol. 153, No. 2, 02.2007, p. 289-295.

Research output: Contribution to journalArticle

Szük, T, Gyöngyösi, M, Homorodi, N, Kristóf, È, Király, C, Èdes, IF, Facskó, A, Pavo, N, Sodeck, G, Strehblow, C, Farhan, S, Maurer, G, Glogar, D, Domanovits, H, Huber, K & Édes, I 2007, 'Effect of timing of clopidogrel administration on 30-day clinical outcomes: 300-mg loading dose immediately after coronary stenting versus pretreatment 6 to 24 hours before stenting in a large unselected patient cohort', American Heart Journal, vol. 153, no. 2, pp. 289-295. https://doi.org/10.1016/j.ahj.2006.10.030
Szük, Tibor ; Gyöngyösi, Mariann ; Homorodi, Nóra ; Kristóf, Èva ; Király, Csaba ; Èdes, István F. ; Facskó, Andrea ; Pavo, Noemi ; Sodeck, Gottfried ; Strehblow, Christoph ; Farhan, Serdar ; Maurer, Gerald ; Glogar, Dietmar ; Domanovits, Hans ; Huber, Kurt ; Édes, I. / Effect of timing of clopidogrel administration on 30-day clinical outcomes : 300-mg loading dose immediately after coronary stenting versus pretreatment 6 to 24 hours before stenting in a large unselected patient cohort. In: American Heart Journal. 2007 ; Vol. 153, No. 2. pp. 289-295.
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abstract = "Background: The aim of our prospective multicenter Clopidogrel Registry was to evaluate the efficacy and safety of a 300-mg loading dose of clopidogrel at the time of ad hoc stenting in patients with suspected coronary artery disease who were not pretreated with clopidogrel for any reason, and to compare the 30-day clinical event rates with the outcome of patients pretreated with a loading dose of clopidogrel 6 to 24 hours before stenting. Methods: Between March 2002 and February 2004, 4160 consecutively included patients received a 300-mg loading dose of clopidogrel immediately after (group 1, n = 2679) or 6 to 24 hours before stenting (group 2, n = 1481). Results: The primary end point (triple composite end point of acute myocardial infarction, all-cause death, and urgent repeat target vessel revascularization) at 30 days occurred in 4.74{\%} versus 2.77{\%} in groups 1 and 2, respectively (P = .002). The secondary end point events, the stent thrombosis, occurred significantly more frequently in group 1, with a trend toward increase in incidence of death, target vessel revascularization, or need for glycoprotein IIb/IIIa antagonists during percutaneous coronary intervention. Pretreatment with clopidogrel was associated with more major bleeding (secondary safety end point) (0.41{\%} vs 1.35{\%} in groups 1 and 2, respectively; P = .001). Conclusions: The results of our multicenter prospective Clopidogrel Registry demonstrate lower efficacy of a 300-mg loading dose of clopidogrel at the time of stenting compared with pretreatment 6 to 24 hours before percutaneous coronary intervention on the 30-day composite clinical end point in the large unselected patient cohort, which suggests the benefit of clopidogrel pretreatment in all incoming patients with suspected significant coronary artery disease scheduled for coronary angiography.",
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T2 - 300-mg loading dose immediately after coronary stenting versus pretreatment 6 to 24 hours before stenting in a large unselected patient cohort

AU - Szük, Tibor

AU - Gyöngyösi, Mariann

AU - Homorodi, Nóra

AU - Kristóf, Èva

AU - Király, Csaba

AU - Èdes, István F.

AU - Facskó, Andrea

AU - Pavo, Noemi

AU - Sodeck, Gottfried

AU - Strehblow, Christoph

AU - Farhan, Serdar

AU - Maurer, Gerald

AU - Glogar, Dietmar

AU - Domanovits, Hans

AU - Huber, Kurt

AU - Édes, I.

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N2 - Background: The aim of our prospective multicenter Clopidogrel Registry was to evaluate the efficacy and safety of a 300-mg loading dose of clopidogrel at the time of ad hoc stenting in patients with suspected coronary artery disease who were not pretreated with clopidogrel for any reason, and to compare the 30-day clinical event rates with the outcome of patients pretreated with a loading dose of clopidogrel 6 to 24 hours before stenting. Methods: Between March 2002 and February 2004, 4160 consecutively included patients received a 300-mg loading dose of clopidogrel immediately after (group 1, n = 2679) or 6 to 24 hours before stenting (group 2, n = 1481). Results: The primary end point (triple composite end point of acute myocardial infarction, all-cause death, and urgent repeat target vessel revascularization) at 30 days occurred in 4.74% versus 2.77% in groups 1 and 2, respectively (P = .002). The secondary end point events, the stent thrombosis, occurred significantly more frequently in group 1, with a trend toward increase in incidence of death, target vessel revascularization, or need for glycoprotein IIb/IIIa antagonists during percutaneous coronary intervention. Pretreatment with clopidogrel was associated with more major bleeding (secondary safety end point) (0.41% vs 1.35% in groups 1 and 2, respectively; P = .001). Conclusions: The results of our multicenter prospective Clopidogrel Registry demonstrate lower efficacy of a 300-mg loading dose of clopidogrel at the time of stenting compared with pretreatment 6 to 24 hours before percutaneous coronary intervention on the 30-day composite clinical end point in the large unselected patient cohort, which suggests the benefit of clopidogrel pretreatment in all incoming patients with suspected significant coronary artery disease scheduled for coronary angiography.

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