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Clopidogrel reloading worthwhile in acute coronary syndromes
Date:4/1/2008

of cardiology at Campus Biomedico, University of Rome, Italy. In patients with stable syndromes, ongoing preexisting clopidogrel may supply sufficient anti-platelet effect to safely undergo the procedure.

For the study, Dr. Di Sciascio and his colleagues recruited a total of 436 patients who had been taking clopidogrel for more than 10 days before PCI. Of these, 167 (38 percent) had ACS. Patients were randomly assigned to receive an additional 600-mg loading dose of clopidogrel four to eight hours before PCI or to receive a placebo. Blood tests confirmed that platelet reactivity was significantly lower in the reload group when compared with the placebo group in patients with ACS.

After 30 days follow-up, the overall rates of major adverse cardiac events (MACE)consisting of death, heart attack, or repeat PCI or bypass surgerywere the same in the two groups: 7 percent in patients who received clopidogrel reloading vs. 9 percent in the placebo group (p=0.70). A similar finding was observed in patients with stable chest pain (8 percent vs. 4 percent, respectively, p=0.23). However, in patients with acute coronary syndromes, clopidogrel reloading significantly reduced the MACE rate (7 percent vs. 18 percent, respectively; odds ratio: 0.36; p=0.035). There was no difference in the rates of bleeding (5 percent in both groups).

Fundamental differences in the cardiovascular conditions that characterize acute and stable chest pain may explain the effectiveness of clopidogrel reloading in patients with ACS, Dr. Di Sciascio said. Patients with ACS have higher platelet reactivity, higher inflammatory status and more intracoronary thrombus, he said. This may make them more prone to benefit from clopidogrel reloading.

Dr. Di Sciascio will present the results of the "Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty-RELOAD (ARMYDA-RELOAD) study on Tuesday, April 1 at 11:30 a.m. CDT in the Grand Ballroom, S100.


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Contact: Kathy Boyd David
pr@scai.org
717-422-1181
Weber Shandwick Worldwide
Source:Eurekalert

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