Impact of a 600-mg Loading Dose of Clopidogrel on 30-Day Outcome in Unselected Patients Undergoing Percutaneous Coronary Intervention

Laurent Bonello, Gilles Lemesle, Axel De Labriolle, Probal Roy, Daniel H. Steinberg, Tina L. Pinto Slottow, Zhenyi Xue, Rebecca Torguson, William O. Suddath, Lowell F. Satler, Kenneth M. Kent, Augusto D. Pichard, Joseph Lindsay, Ron Waksman*

*Corresponding author for this work

    Research output: Contribution to journalArticle

    19 Citations (Scopus)

    Abstract

    On the basis of biologic studies of platelet reactivity, the recent American College of Cardiology and American Heart Association guidelines recommend a 600-mg loading dose (LD) of clopidogrel in patients who undergo percutaneous coronary intervention (PCI). There is, however, a lack of studies addressing the clinical impact of such a clopidogrel LD. The aim of this study was to compare the clinical efficacy and safety of a 600-mg LD of clopidogrel with that of a 300-mg LD in an unselected cohort of patients who underwent PCI. A cohort of 4,105 unselected patients who underwent PCI were included in the study and divided according to the LD used: the high-LD group (600 mg) included 3,146 patients, and the low-LD group (300 mg) included 959. The primary end point was the rate of major adverse cardiovascular events (MACEs) at 1 month. Patients in the low-LD group more often had diabetes mellitus and histories of myocardial infarction (36.8% vs 31.9%, p = 0.01). Left ventricular ejection fractions were similar (0.49 ± 0.14 vs 0.48 ± 0.14, p = 0.25). Angiographic and procedural characteristics were identical between the 2 groups. Patients in the high-LD group had fewer MACEs after 1 month (2.9% vs 5.2%, p <0.001). In multivariate analysis, an LD of 600 mg was significantly associated with MACEs at 1-month follow-up, with an odds ratio of 0.62 (95% confidence interval 0.41 to 0.95, p = 0.03). In conclusion, a 600-mg LD was associated with a significant decrease in the rate of post-PCI MACEs at 1 month, without any in-hospital increase in bleeding complications. The results of this study therefore support the current guidelines of a 600-mg LD of clopidogrel in patients who undergo PCI.

    Original languageEnglish
    Pages (from-to)1318-1322
    Number of pages5
    JournalAmerican Journal of Cardiology
    Volume102
    Issue number10
    DOIs
    Publication statusPublished - 15 Nov 2008

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