Does high-dose clopidogrel have a benefit following PCI?

January 01, 0001

Does high-dose clopidogrel have a benefit following PCI?

High platelet reactivity has been linked to higher cardiovascular risk following percutaneous coronary intervention (PCI). This group of US and Canadian researchers examined high-dose clopidogrel therapy in patients with high platelet reactivity following PCI with drug eluting stents. They performed a randomized, double-blind, active-control trial (Gauging Responsiveness with A VerifyNow assay—Impact on Thrombosis And Safety {GRAVITAS}, n=2214) randomizing patients to either high-dose clopidogrel (600- mg initial dose, then 150 mg daily) or standard-dose clopidogrel (no additional loading dose, 75 mg daily). The patients were followed for 6 months.

The researchers found: "At 6 months, the primary end point had occurred in 25 of 1109 patients (2.3%) receiving high-dose clopidogrel compared with 25 of 1105 patients (2.3%) receiving standard-dose clopidogrel (hazard ratio {HR}, 1.01). Severe or moderate bleeding was not increased with the high-dose regimen (15 {1.4%} vs 25 {2.3%}, HR, 0.59). Compared with standard-dose clopidogrel, high-dose clopidogrel provided a 22% absolute reduction in the rate of high on-treatment reactivity at 30 days (62 vs 40%)."

The researchers concluded: "Among patients with high on-treatment reactivity after PCI with drug-eluting stents, the use of high-dose clopidogrel compared with standard-dose clopidogrel did not reduce the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or stent thrombosis."

High dose clopidogrel does not improve outcomes in patient with high platelet reactivity following durg-eluting stent placement.

For the full abstract, click here.

JAMA 305(11):1097-1105, 16 March 2011 © 2011 American Medical Association
Standard- vs High-Dose Clopidogrel Based on Platelet Function Testing After Percutaneous Coronary Intervention. Matthew J. Price, Peter B. Berger, Paul S. Teirstein, et al.

Category: K. Circulatory. Keywords: clopidogrel, high-dose, coronary artery disease, drug-eluting stents, myocardial infarction, randomized controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 22 April 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.