Key result
Early clopidogrel loading is linked to ~54% fewer MACE vs late loading in aspirin-resistant patients.
Why the study?
Optimal antiplatelet strategy for coronary stenting is unknown among patients with aspirin resistance who remain at risk of recurrent adverse cardiovascular events despite dual antiplatelet therapy.
Does early loading of clopidogrel reduce major adverse cardiac events in aspirin-resistant patients undergoing elective coronary stenting?
Cohort (n=240)
Does early loading of clopidogrel reduce major adverse cardiac events in aspirin-resistant patients undergoing elective coronary stenting?
Loading clopidogrel more than 6 hours before elective PCI significantly reduces major adverse cardiac events in aspirin-resistant patients without increasing bleeding risk.
May support early clopidogrel loading in aspirin-resistant elective PCI patients; hypothesis-generating and requires randomized confirmation before practice change.
We aimed to analyze the clinical effect of clopidogrel loading time on adverse cardiovascular events among patients with aspirin resistance. Recurrent adverse events may still occur despite dual antiplatelet therapy after coronary stenting. Aspirin resistance is one of the possible reasons of this trouble. Optimal antiplatelet strategy for coronary stenting is unknown among patients with aspirin resistance. A total of 980 patients scheduled for elective coronary stenting were enrolled and allocated into two groups according to the loading time of clopidogrel more or less than 6 hours before coronary intervention (early- or late-loaded groups, respectively). Aspirin resistance was determined according to the urinary levels of 11-dehydrothromboxane B2. Overall 240 patients who were allocated to early- and late-loaded groups were identified as aspirin resistant according to the urinary levels of 11-dehydrothromboxane B2. After a follow-up period of 12 months major adverse cardiac events were observed among 16 patients (13.9%) in the early-loaded group and 30 patients (25.8%) in the late-loaded group (p = 0.02). Early loading of clopidogrel was an independent predictor of lower rate of cardiac events (hazard ratio = 0.46 [0.32-0.76, 95% confidence interval], p = 0.001). The rates of bleeding events and periprocedural myocardial infarction were similar in early- and late-loaded groups. The current study demonstrated that loading of clopidogrel earlier than 6 hours before elective coronary stenting among aspirin-resistant patients was associated with increased benefits for ischemic events with similar bleeding rates.
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Tutar et al. (2015) conducted a cohort in Aspirin resistance in elective percutaneous coronary intervention (n=240). Early loading of clopidogrel (≥6 hours before intervention) vs. Late loading of clopidogrel (<6 hours before intervention) was evaluated on Major adverse cardiac events (HR 0.46, 95% CI 0.32-0.76, p=0.001). Early loading of clopidogrel (≥6 hours before PCI) was associated with fewer major adverse cardiac events than late loading in aspirin-resistant patients (HR 0.46; 95% CI 0.32-0.76; p=0.001).
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