What is the clinical evidence from this study?

Study design: RCT. Population: Coronary stenting (n=190). Intervention: Clopidogrel vs. 300-mg loading dose. Primary outcome: Nonresponsiveness (<10% absolute change in platelet aggregation) with 5 microM ADP (p=<0.001).

What does this research mean for the field?

A 600-mg clopidogrel loading dose significantly reduces the incidence of platelet nonresponsiveness and high post-treatment platelet aggregation compared to a standard 300-mg loading dose in patients undergoing coronary stenting. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine the effect of a 300-mg versus a 600-mg clopidogrel loading dose on the incidence of nonresponsiveness and high post-treatment platelet aggregation.

September 20, 2026Journal of the American College of CardiologyOpen Access

The Relation of Dosing to Clopidogrel Responsiveness and the Incidence of High Post-Treatment Platelet Aggregation in Patients Undergoing Coronary Stenting

Q: What are the key findings of this study?

A 600-mg clopidogrel loading dose reduced the incidence of nonresponsiveness compared to a 300-mg dose (8% vs. 28% with 5 microM ADP, p<0.001) in patients undergoing coronary stenting.

Q: What does this research mean for the field?

A 600-mg clopidogrel loading dose significantly reduces the incidence of platelet nonresponsiveness and high post-treatment platelet aggregation compared to a standard 300-mg loading dose in patients undergoing coronary stenting. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine the effect of a 300-mg versus a 600-mg clopidogrel loading dose on the incidence of nonresponsiveness and high post-treatment platelet aggregation.

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Key result

A 600-mg clopidogrel loading dose reduces nonresponsiveness ~71% versus 300-mg during coronary stenting.

P<0.001
n=190

Why the study?

Limited information is available on the comparative effect of a 600-mg versus a 300-mg clopidogrel loading dose on nonresponsiveness and high post-treatment platelet aggregation in patients undergoing coronary stenting.

Does a 600-mg clopidogrel loading dose reduce nonresponsiveness and high post-treatment platelet aggregation compared to a 300-mg dose in patients undergoing coronary stenting?

Population

190 patients undergoing coronary stenting

Comparison

600-mg clopidogrel loading dose vs 300-mg clopidogrel loading dose

Design

Randomized treatment allocation

Authors

PGPaul A. GurbelInterventional Cardiology KBKevin P. BlidenInterventional Cardiology KHKevin HayesBoston University

Discussion

Member takes

Implication

A 600-mg clopidogrel loading dose significantly reduces the incidence of nonresponsiveness and high post-treatment platelet aggregation compared to a standard 300-mg dose in patients undergoing coronary stenting.

Key Points

To determine the effect of a 300-mg versus a 600-mg clopidogrel loading dose on the incidence of nonresponsiveness and high post-treatment platelet aggregation.
Randomized trial of 190 patients undergoing coronary stenting treated with either a 300-mg or a 600-mg clopidogrel loading dose.
Nonresponsiveness was defined as <10% absolute change in platelet aggregation, and high post-treatment platelet aggregation was defined as >75th percentile aggregation after a 300-mg dose.
Nonresponsiveness was significantly lower with the 600-mg dose compared to 300 mg at 5 µM ADP (8% vs. 28%) and at 20 µM ADP (8% vs. 32%, p < 0.001).
Among patients with high post-treatment platelet aggregation after 300 mg clopidogrel, 62% to 65% exhibited nonresponsiveness, whereas 100% of those with high post-treatment aggregation after 600 mg had nonresponsiveness.

Study Design

Type

RCT (n=190)

Structured PICO

Does a 600-mg clopidogrel loading dose reduce nonresponsiveness and high post-treatment platelet aggregation compared to a 300-mg dose in patients undergoing coronary stenting?

Population

190 patients undergoing coronary stenting.

Intervention

600-mg clopidogrel loading dose

Comparator

300-mg clopidogrel loading dose

Outcome

Clopidogrel responsiveness (nonresponsiveness defined as <10% absolute change in platelet aggregation) and high post-treatment platelet aggregation (>75th percentile aggregation after 300 mg clopidogrel)surrogate

Main Result

Absolute Event Rate: 8% vs 28%

p-value: p=<0.001

Cite This Study

Gurbel et al. (2005) conducted an RCT in Coronary stenting (n=190). Clopidogrel vs. 300-mg loading dose was evaluated on Nonresponsiveness (<10% absolute change in platelet aggregation) with 5 microM ADP (p=<0.001). A 600-mg clopidogrel loading dose reduced the incidence of nonresponsiveness compared to a 300-mg dose (8% vs. 28% with 5 microM ADP, p<0.001) in patients undergoing coronary stenting.

synapsesocial.com/papers/6ab04d18cdc128587b47ec9f https://doi.org/10.1016/j.jacc.2005.01.030

Topics

Dual antiplatelet therapy

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The Relation of Dosing to Clopidogrel Responsiveness and the Incidence of High Post-Treatment Platelet Aggregation in Patients Undergoing Coronary Stenting

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

The Relation of Dosing to Clopidogrel Responsiveness and the Incidence of High Post-Treatment Platelet Aggregation in Patients Undergoing Coronary Stenting

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider