Key result
In patients receiving one-stop hybrid coronary revascularization, a 600 mg clopidogrel loading dose did not significantly increase PLATO major bleeding compared with a 300 mg dose (76% vs. 70%, p=0.50).
Why the study?
The optimal loading dose of clopidogrel in one-stop hybrid coronary revascularization remains unknown.
Does a clopidogrel 600 mg loading dose increase major bleeding events compared to a 300 mg loading dose in patients undergoing one-stop hybrid coronary revascularization?
RCT (n=100)
Single-blind
1:1 ratio
No
Does a clopidogrel 600 mg loading dose increase major bleeding events compared to a 300 mg loading dose in patients undergoing one-stop hybrid coronary revascularization?
Absolute Event Rate: 76% vs 70%
p-value: p=0.50
In patients undergoing one-stop hybrid coronary revascularization, a 600 mg loading dose of clopidogrel did not significantly increase major bleeding events compared to a 300 mg dose, suggesting its safety in this setting.
Clopidogrel 600 mg loading shows similar bleeding and ischemic risks to 300 mg in one-stop HCR; larger trials needed to assess net benefit.
Background: The optimal loading dose of clopidogrel in one-stop hybrid coronary revascularization (HCR) remains an “evidence-free” zone. This study aimed to compare the major bleeding and ischemic thrombotic events between different clopidogrel loading doses (300 vs. 600 mg) in one-stop HCR. Methods: In this prospective, single-center, randomized, and parallel pilot study, 100 patients receiving one-stop HCR were randomly assigned to the clopidogrel loading dose 300-mg group or 600-mg group in a 1:1 ratio. Major bleeding events and composite in-hospital ischemic thrombotic and adverse complications were evaluated after the procedure. Results: The results showed that postoperative mean chest drainage of the first 4 days and total drainage were comparable between the two groups. No differences were found in Bleeding Academic Research Consortium (BARC) coronary artery bypass grafting (CABG) related bleeding (4 vs. 2%, P = 1), PLATelet inhibition and patient Outcomes (PLATO) life-threatening bleeding (20 vs. 26%, P = 0.48), and PLATO major bleeding (70 vs. 76%, P = 0.5) in the two groups. The composite ischemic thrombotic and adverse events were also similar. Conclusions: In patients receiving one-stop HCR, clopidogrel 600 mg loading dose did not increase major bleeding events compared with 300 mg. More sufficient data is necessary to evaluate the potential benefits of 600 mg loading dose in one-stop HCR.
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Guo et al. (2021) conducted an RCT in Multivessel coronary artery disease (n=100). Clopidogrel vs. 300 mg loading dose was evaluated on PLATO major bleeding (p=0.50). In patients receiving one-stop hybrid coronary revascularization, a 600 mg clopidogrel loading dose did not significantly increase PLATO major bleeding compared with a 300 mg dose (76% vs. 70%, p=0.50).
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