Clopidogrel conferred similar protection as ticlopidine against major adverse cardiac events (3.85% vs 4.60%; P=0.551) and stent thrombosis (2.02% vs 1.92%; P=0.901) at 30 days.
RCT (n=1,016)
randomly assigned
Does clopidogrel prevent subacute stent thrombosis and major adverse cardiac events as effectively as ticlopidine in patients after intracoronary stent implantation?
Clopidogrel provides similar protection against stent thrombosis and MACE as ticlopidine after coronary stenting, but is significantly better tolerated.
Absolute Event Rate: 3.85% vs 4.6%
p-value: p=0.551
BACKGROUND: Although clopidogrel is used to prevent subacute stent thrombosis, its safety and efficacy have not been compared with ticlopidine in a randomized manner in the United States. METHODS AND RESULTS: Patients with successful intracoronary stent implantation were randomly assigned to therapy with ticlopidine or clopidogrel. Loading doses were administered immediately after the procedure, and the drugs were prescribed for 2 weeks. One thousand sixteen patients were enrolled: 522 patients were randomly assigned to ticlopidine therapy and 494 to clopidogrel. High-risk characteristics included recent myocardial infarction in 41.4% of the cases, angiographically evident thrombus in 20.9%, and abrupt or threatened closure in 3.64%. An intravenous glycoprotein IIb/IIIa inhibitor was used in 48.2% of the cases, and thrombocytopenia occurred in 1.43% of these patients. Failure to complete 2 weeks of therapy occurred in 3.64% of the patients treated with ticlopidine and in 1.62% of the patients treated with clopidogrel (P=0.043). Within 30 days, thrombosis of the stent occurred in 1.92% of the patients in the ticlopidine group and in 2.02% of the clopidogrel group (P=0.901). A major adverse cardiac event occurred in 4.60% of patients receiving ticlopidine and in 3.85% of patients receiving clopidogrel (P=0.551). CONCLUSIONS: Clopidogrel is better tolerated than ticlopidine during a 2-week regimen after intracoronary stent implantation. Combining either thienopyridine with an intravenous platelet IIb/IIIa inhibitor appears to be safe. When applied to a broad spectrum of patients receiving stent implantation, clopidogrel confers similar protection as ticlopidine against subacute stent thrombosis and major adverse cardiac events.
Taniuchi et al. (Tue,) conducted a rct in intracoronary stent implantation (n=1,016). Clopidogrel vs. Ticlopidine was evaluated on major adverse cardiac event (p=0.551). Clopidogrel conferred similar protection as ticlopidine against major adverse cardiac events (3.85% vs 4.60%; P=0.551) and stent thrombosis (2.02% vs 1.92%; P=0.901) at 30 days.
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