Rationale and Role of High Loading Dose Clopidogrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Abstract

Antiplatelet therapy, which reduces platelet activation and aggregation, is the corner stone of treatment for patients undergoing percutaneous coronary intervention (PCI). Clopidogrel is an established oral antiplatelet medication of thienopyridine class, which inhibits blood clots in coronary artery disease, peripheral vascular disease, and cerebrovascular disease. Many studies have revealed that high loading dose clopidogrel in patients undergoing PCI. This review article investigates the rationale and role of high loading dose clopidogrel in patients undergoing PCI.

Share and Cite:

S. Mathew, G. S, P. V and V. B, "Rationale and Role of High Loading Dose Clopidogrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention," Pharmacology & Pharmacy, Vol. 3 No. 4, 2012, pp. 481-484. doi: 10.4236/pp.2012.34066.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] K. Amit and P. C. Christopher, “Acute Coronary Syndromes: Diagnosis and Management, Part I,” Mayo Clin Proc, Vol. 84, 2009, pp. 917-38.
[2] S. C. Smith, T. E. Feldman and J. W. Hirshfeld, “ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for Percutaneous Coronary Intervention) ,” Circulation, Vol. 113, 2006, pp. 166-286.
[3] S. Silber, P. Albertsson and F. F. Aviles, “Guidelines for percutaneous coronary interventions: the Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology,” Eur Heart J, Vol. 26, 2005, pp. 804-847.
[4] M. D. Quinn, J. Martin, J. Desmond and M. D. Fitzgerald, “Ticlopidine and Clopidogrel,” Circulation, Vol. 100, 1999, pp. 1667-1672.
[5] S. D. Wiviott, D. Trenk and A. L. Frelinger, “Prasugrel compared with high loading- and maintenance-dose clopidogrel in patients with planned percutaneous coronary intervention: the Prasugrel in Comparison to Clopidogrel for Inhibition of Platelet Activation and Aggregation–Thrombolysis in Myocardial Infarction 44 trial,” Circulation, Vol. 116, 2007, pp. 2923-2932.
[6] Caprie Steering Committee, “A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE),” Lancet, Vol. 348, 1996, pp. 1329–1339.
[7] S. Yusuf, F. Zhao and S. R. Mehta, “For the Clopidogrel in Unstable Angina to Prevent Recurrent Ischemic Events (CURE) Trial Investigators: Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation,” N Engl J Med, Vol. 345, 2001, pp. 494-502.
[8] S. R. Mehta, S. Yusuf and R. J. Peters, “Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study,” Lancet, Vol. 358, 2001, pp. 527-533.
[9] S. B. King, S. C. Smith and J. W. Hirshfeld, “Focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines,” Vol. 117, No. 6, 2008, pp. 261-295.
[10] S. R. Steinhubl, P. B. Berger and J. T. Mann, “Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial,” JAMA, Vol. 288, 2002, pp. 2411-2420.
[11] P. A. Gurbel, K. P. Bliden and B. L. Hiatt, “Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity,” Circulation, Vol. 107, 2003, pp. 2908-2913.
[12] D. J. Angiolillo, A. Fernandez-Ortiz and E. Bernardo,“Identification of low responders to a 300-mg clopidogrel loading dose in patients undergoing coronary stenting,” Thromb Res, Vol. 115, 2005, pp. 101-108.
[13] P. Jaremo, T. L. Lindahl and S. G. Fransson, “Individual variations of platelet inhibition after loading doses of clopidogrel,” J Intern Med,Vol. 252, 2002, pp. 233-238.
[14] I. Muller, F. Besta and C. Schulz, “Prevalence of clopidogrel non-responders among patients with stable angina pectoris scheduled for elective coronary stent placement,” Thromb Haemost, Vol. 89, 2003, pp. 783-787.
[15] V. L. Serebruany, S. R. Steinhubl and P. B. Berger, “Variability in platelet responsiveness to clopidogrel among 544 individuals,” J Am Coll Cardiol, Vol. 45, 2005, pp. 246-251.
[16] P. Barragan, J. L. Bouvier and P. O. Roquebert. “Resistance to thienopyridines: clinical detection of coronary stent thrombosis by monitoring of vasodilator-stimulated phosphoprotein phosphorylation,” Catheter Cardiovasc Interv, Vol. 59, 2003, pp. 295-302.
[17] P. A. Gurbel, K. P. Bliden and W. Samara, “Clopidogrel effect on platelet reactivity in patients with stent thrombosis: results of the CREST study,” J Am Coll Cardiol, Vol. 46, 2005, pp. 1827-1832.
[18] P. Wenaweser and O. Hess, “Stent thrombosis is associated with an impaired response to antiplatelet therapy,” J Am Coll Cardiol, Vol. 46, 2005, pp. CS5-6.
[19] S. Matetzky, B. Shenkman and V. Guetta. “Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction,” Circulation, Vol. 109, 2004, pp. 3171-3175.
[20] G. Montalescot, G. Sideris, C. Meuleman and C. Baldit-Sollier, “A randomized comparison of high clopidogrel loading doses in patients with non-ST-segment elevation acute coronary syndromes: the ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) trial,” J Am Coll Cardiol, Vol. 48, 2006, pp. 931-938.
[21] G. Patti, G. Colonna and V. Pasceri, “Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention. Results from the ARMYDA-2 (Antiplatelet therapy for Reduction of Myocardial Damage during Angioplasty) study,” Circulation, Vol. 111, 2005, pp. 2099-2116.
[22] T. Cuisset, C. Frere and J. Quilici. “Benefit of a 600-mg loading dose of clopidogrel on platelet reactivity and clinical outcomes in patients with non-ST-segment elevation acute coronary syndrome undergoing coronary stenting,” J Am Coll Cardiol, Vol. 48, 2006, pp. 1339-1345.
[23] Han Ya-ling, Wang Bin, Li Yi, Xu Kai, “A high maintenance dose of clopidogrel improves short-term clinical outcomes in patients with acute coronary syndrome undergoing drug-eluting stent implantation,” Chin Med J, Vol. 122, 2009, pp. 793-797.
[24] W. Rosamond, K. Flegal and G. Friday, “For the American Heart Association Statistics Committee and Stroke Statistics Subcommittee: Heart disease and stroke statistics–2007 update: A report from the American heart association statistics committee and stroke statistics subcommittee,” Circulation, Vol. 115, 2007, pp. e69-e171.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.