Key result
Higher loading doses of clopidogrel (450 mg and 600 mg) provided earlier ST resolution, lower peak cardiac enzymes, and lower hs-CRP levels compared to 300 mg in STEMI patients (p<0.05).
Why the study?
Does a higher loading dose of clopidogrel (450 mg or 600 mg) improve ST segment resolution and reduce cardiac enzymes and hs-CRP compared to a 300 mg loading dose in STEMI patients treated with fibrinolytic therapy?
Does a higher loading dose of clopidogrel (450 mg or 600 mg) improve ST segment resolution and reduce cardiac enzymes and hs-CRP compared to a 300 mg loading dose in STEMI patients treated with fibrinolytic therapy?
Higher loading doses of clopidogrel (up to 600 mg) in STEMI patients receiving fibrinolytic therapy are associated with faster ST-segment resolution and lower markers of myocardial injury and inflammation compared to a standard 300 mg loading dose.
Higher clopidogrel loading doses accelerate ST resolution and blunt enzyme/CRP rises in fibrinolytic STEMI; extends dosing optimization data for this reperfusion strategy.
PURPOSE: The purpose of the present study was to evaluate the effects of different loading doses of clopidogrel on ST segment resolution on ECG, changes in cardiac enzyme levels and serum levels of high-sensitivity C-reactive protein (Hs-CRP) in patients with ST elevated myocardial infarction (STEMI) treated with fibrinolytic therapy. METHODS: Patients admitted to our cardiology clinic with a diagnosis of STEMI and treated with fibrinolytic therapy were included: Group 1 (n=58) received a 300 mg loading dose of clopidogrel, Group 2 (n=55) a 450 mg loading dose and Group 3 (n=59) a 600 mg loading dose. A 75 mg/d maintanence dose of clopidogrel was given in all groups. RESULTS: All demographic characteristics and baseline laboratory parameters were statistically similar among three groups (p > 0.05). When ST resolution periods were compared, most patients in Group 3 had ST resolution at 30 minutes; Group 2 at 60 minutes and Group 1 at 90 minutes (p < 0.05). Peak levels of creatine kinase (CK) and CK-MB were as follows: Group 3, 8(th) hour, Group 1 and 2, 12(th) hour. Peak levels of those enzymes were significantly lower in Group 3 than in Group 1 and 2 ( < 0.05). Although basal hs-CRP levels of all groups were similar, the increase in hs-CRP levels at 48 hours was lower with higher clopidogrel loading doses (p < 0.05). CONCLUSION: In this study comparing three different clopidogrel loading doses, the higher doses provided earlier ECG resolution, earlier and lower peak CK and CK-MB levels and lower levels of hs-CRP.
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Solmaz et al. (2013) studied ST elevated myocardial infarction (STEMI) (n=172). Clopidogrel vs. 300 mg loading dose was evaluated on ST segment resolution on ECG, changes in cardiac enzyme levels and serum levels of high-sensitivity C-reactive protein (Hs-CRP) (p=< 0.05). Higher loading doses of clopidogrel (450 mg and 600 mg) provided earlier ST resolution, lower peak cardiac enzymes, and lower hs-CRP levels compared to 300 mg in STEMI patients (p<0.05).
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