Dosing of clopidogrel and aspirin for acute coronary syndromes

January 01, 0001

Dosing of clopidogrel and aspirin for acute coronary syndromes

Clopidogrel and aspirin are widely used for patients with acute coronary syndromes and those undergoing percutaneous coronary intervention (PCI). These investigators from multiple countries randomly assigned, in a 2-by-2 factorial design, 25,086 patients with an acute coronary syndrome who were referred for an invasive strategy to either double-dose clopidogrel (a 600-mg loading dose on day 1, followed by 150 mg daily for 6 days and 75 mg daily thereafter) or standard-dose clopidogrel (a 300-mg loading dose and 75 mg daily thereafter) and either higher-dose aspirin (300 to 325 mg daily) or lower-dose aspirin (75 to 100 mg daily). The primary outcome was a composite of cardiovascular death, myocardial infarction, or stroke at 30 days.

They found: "The primary outcome occurred in 4.2% of patients assigned to double-dose clopidogrel as compared with 4.4% assigned to standard- dose clopidogrel (hazard ratio, 0.94, NS). Major bleeding occurred in 2.5% of patients in the double-dose group and in 2.0% in the standard-dose group (hazard ratio, 1.24; significant). Double-dose clopidogrel was associated with a significant reduction in the secondary outcome of stent thrombosis among the 17,263 patients who underwent PCI (1.6% vs. 2.3%; hazard ratio, 0.68). There was no significant difference between higher-dose and lower-dose aspirin with respect to the primary outcome (4.2% vs. 4.4%; hazard ratio, 0.97) or major bleeding (2.3% vs. 2.3%; hazard ratio, 0.99)."

The authors concluded: "In patients with an acute coronary syndrome who were referred for an invasive strategy, there was no significant difference between a 7-day, double-dose clopidogrel regimen and the standard- dose regimen, or between higher-dose aspirin and lower-dose aspirin, with respect to the primary outcome of cardiovascular death, myocardial infarction, or stroke."

There in no evidence for superiority of high-dose therapy of either agent.

For the full abstract, click here.

N Engl J Med 363:930-942, 2 September 2010 © 2010 to the Massachusetts Medical Society
Dose Comparisons of Clopidogrel and Aspirin in Acute Coronary Syndromes. The CURRENT-OASIS 7 Investigators. Correspondence to Dr. Mehta: [email protected]

Category: K. Circulatory. Keywords: acute coronary syndrome, percutaneous coronary intervention, clopidogrel, aspirin, death, myocardial infarction, stroke, bleeding, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 14 September 2010

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