Clinical Studies
Clopidogrel as adjunctive antiplatelet therapy during coronary stenting

https://doi.org/10.1016/S0735-1097(99)00443-XGet rights and content
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Abstract

OBJECTIVES

We examined the procedural and 30-day clinical outcomes among patients receiving aspirin and either ticlopidine or clopidogrel during coronary stenting.

BACKGROUND

Ticlopidine-plus-aspirin has become standard antiplatelet therapy for the prevention of thrombotic complications after coronary stenting. Clopidogrel has a similar mechanism of action as ticlopidine, but both its efficacy and its safety as a pharmacologic adjunct to coronary stenting have not been well described.

METHODS

This single-center, prospective analysis examined the in-hospital procedural and 30-day clinical outcomes among 875 consecutive patients undergoing coronary stenting who received adjunctive aspirin and either clopidogrel (n = 514; 58.7%) or ticlopidine (n = 361; 41.3%) therapy.

RESULTS

Procedural success rates were similar among the clopidogrel- (99.6%) and ticlopidine-treated patients (99.4%). Subacute stent thrombosis (i.e., >24 h ≤30 days) occurred in one clopidogrel-treated (0.2%) and in one ticlopidine-treated (0.3%) patient (p = 0.99). By 30 days following the index procedure, the combined rates of death, nonfatal myocardial infarction and need for target vessel revascularization were similar among patients who received either clopidogrel (2.1%) or ticlopidine (1.4%; p = 0.57) therapy.

CONCLUSIONS

In this analysis the antiplatelet combination therapy of aspirin-plus-clopidogrel was an effective regimen for preventing thrombotic complications and major adverse cardiovascular events among a broad spectrum of patients undergoing coronary artery stenting.

Abbreviations

ACT
activated clotting time
AST
acute stent thrombosis
CABG
coronary artery bypass grafting
CK
creatinine kinase
GPIIb/IIIa
glycoprotein IIb/IIIa inhibitor
MACE
major adverse cardiac event
MI
myocardial infarction
PCI
percutaneous coronary intervention
SST
subacute stent thrombosis
TVR
target vessel revascularization

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This study was supported by an unrestricted educational grant from Bristol-Myers Squibb and Sanofi Pharmaceuticals.