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Emerging Data Regarding the Potential Benefits of Early Initiation of Clopidogrel Among ACS Patients. C. Michael Gibson, M.S., M.D. Inhibition of Platelet Aggregation Following Clopidogrel Administration. Hochholzer W et al. Circulation. 2005;111. Clopidogrel.
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Emerging Data Regarding the Potential Benefits of Early Initiation of Clopidogrel Among ACS Patients C. Michael Gibson, M.S., M.D.
Inhibition of Platelet Aggregation Following Clopidogrel Administration Hochholzer W et al. Circulation. 2005;111
Clopidogrel Clopidogrel Loading Dose Timing and Risk of MACE Log Odds of Death, MI or UTVR at 28 Days Placebo - 2 P = 0.020 for treatment / timing interaction - 3 - 4 - 5 - 6 0 5 10 15 20 25 30 Hours Prior to PCI of Study Drug Loading Dose J Am Coll Cardiol 2006;47:939–43.
Influence of Thienopyridine Exposure – PCI pts 30 Day Primary Endpoint Adverse Events RR [95%CI] 0.81 (0.68-0.96) RR [95%CI] 0.96 (0.77-1.20) RR [95%CI] 0.50 (0.37-0.67) RR [95%CI] 1.07 (0.83-1.39) RR [95%CI] 1.37 (1.00-1.88) RR [95%CI] 0.61 (0.39-0.97) Thienopyridine Exposed Not Thienopyridine Exposed
Clopidogrel stopped <5 days prior to CABG Clopidogrel stopped >5 days prior to CABG CURE: Major Bleeding in CABG Patients • Major or life-threatening bleeding w/in 7 days of CABG P=0.07 P=0.53 K.Fox et al, ESC 2002
ACUITY: Primary Outcomes in CABG Patients • Patients with and without a thienopyridine administered in-hospital prior to CABG P=0.066 P=0.013 P=0.362 *Heparin=unfractionated or enoxaparin
30 Day Outcomes – CABG Patients by Thienopyridine Status • Patients with and without a thienopyridine administered in-hospital prior to CABG