Abstract
Full text: Meta-Analysis Appraising High Clopidogrel Loading in Patients Undergoing Percutaneous Coronary Intervention††Conflicts of interest: Dr. Angiolillo is a consultant and on the speaker's bureau for Bristol Myers Squibb, New York, New York, and Sanofi-Aventis, Paris, France. Dr. Biondi-Zoccai has consulted for Boston Scientific, Natick, Massachusetts, and Cordis, Miami, Florida. Combined antiplatelet treatment with aspirin and clopidogrel is pivotal to minimize periprocedural adverse events in patients who undergo percutaneous coronary intervention. However, there is debate on the best clopidogrel loading dose. The investigators performed a systematic review and meta-analysis of the optimal clopidogrel loading dose. Pertinent trials comparing high (>300 mg) and standard (300 mg) clopidogrel loading doses in patients scheduled for catheterization and/or percutaneous coronary intervention were systematically searched in BioMedCentral, CENTRAL, Google Scholar, and PubMed (December 2006). The primary end point was the 1-month rate of death or myocardial infarction. Secondary end points included other ischemic and bleeding adverse effects. Peto odds ratios were computed. A total of 10 studies (7 randomized, 3 nonrandomized) were included, enrolling 1,567 patients (712 loaded with 300 mg, 11 with 450 mg, 790 with 600 mg, and 54 with 900 mg). Overall, a high loading dose proved significantly superior to a standard loading dose in preventing cardiac death or nonfatal myocardial infarction (odds ratio 0.54, 95% confidence interval 0.32 to 0.90, p = 0.02), without any statistically significant increase in major or minor bleedings (p = 0.55 and p = 0.98, respectively). Sensitivity analysis restricted to randomized trials confirmed the superiority of a high loading dose regimen (p = 0.0031). Meta-regression disclosed a significant interaction between event rate and the benefits of high loading doses (p = 0.005), suggesting that the greater the underlying risk, the greater the favorable impact of a high loading dose. In conclusion, a high clopidogrel loading dose (>300 mg) significantly reduces early ischemic events in patients scheduled for percutaneous coronary intervention.
| Original language | English |
|---|---|
| Pages (from-to) | 1199-1206 |
| Number of pages | 8 |
| Journal | The American Journal of Cardiology |
| Volume | 100 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Oct 15 2007 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Meta-Analysis Appraising High Clopidogrel Loading in Patients Undergoing Percutaneous Coronary Intervention††Conflicts of interest : Dr. Angiolillo is a consultant and on the speaker's bureau for Bristol Myers Squibb, New York, New York, and Sanofi-Aventis, Paris, France. Dr. Biondi-Zoccai has consulted for Boston Scientific, Natick, Massachusetts, and Cordis, Miami ... / Lotrionte, Marzia; Biondi-Zoccai, Giuseppe G L; Agostoni, Pierfrancesco; Abbate, Antonio; Angiolillo, Dominick J.; Valgimigli, Marco; Moretti, Claudio; Meliga, Emanuele; Cuisset, Thomas; Alessi, Marie Christine; Montalescot, Gilles; Collet, Jean Philippe; Di Sciascio, Germano; Waksman, Ron; Testa, Luca; Sangiorgi, Giuseppe; Laudito, Antonio; Trevi, Gian P.; Sheiban, Imad.
In: The American Journal of Cardiology, Vol. 100, No. 8, 15.10.2007, p. 1199-1206.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Meta-Analysis Appraising High Clopidogrel Loading in Patients Undergoing Percutaneous Coronary Intervention††Conflicts of interest
T2 - Dr. Angiolillo is a consultant and on the speaker's bureau for Bristol Myers Squibb, New York, New York, and Sanofi-Aventis, Paris, France. Dr. Biondi-Zoccai has consulted for Boston Scientific, Natick, Massachusetts, and Cordis, Miami ...
AU - Lotrionte, Marzia
AU - Biondi-Zoccai, Giuseppe G L
AU - Agostoni, Pierfrancesco
AU - Abbate, Antonio
AU - Angiolillo, Dominick J.
AU - Valgimigli, Marco
AU - Moretti, Claudio
AU - Meliga, Emanuele
AU - Cuisset, Thomas
AU - Alessi, Marie Christine
AU - Montalescot, Gilles
AU - Collet, Jean Philippe
AU - Di Sciascio, Germano
AU - Waksman, Ron
AU - Testa, Luca
AU - Sangiorgi, Giuseppe
AU - Laudito, Antonio
AU - Trevi, Gian P.
AU - Sheiban, Imad
PY - 2007/10/15
Y1 - 2007/10/15
N2 - Full text: Meta-Analysis Appraising High Clopidogrel Loading in Patients Undergoing Percutaneous Coronary Intervention††Conflicts of interest: Dr. Angiolillo is a consultant and on the speaker's bureau for Bristol Myers Squibb, New York, New York, and Sanofi-Aventis, Paris, France. Dr. Biondi-Zoccai has consulted for Boston Scientific, Natick, Massachusetts, and Cordis, Miami, Florida. Combined antiplatelet treatment with aspirin and clopidogrel is pivotal to minimize periprocedural adverse events in patients who undergo percutaneous coronary intervention. However, there is debate on the best clopidogrel loading dose. The investigators performed a systematic review and meta-analysis of the optimal clopidogrel loading dose. Pertinent trials comparing high (>300 mg) and standard (300 mg) clopidogrel loading doses in patients scheduled for catheterization and/or percutaneous coronary intervention were systematically searched in BioMedCentral, CENTRAL, Google Scholar, and PubMed (December 2006). The primary end point was the 1-month rate of death or myocardial infarction. Secondary end points included other ischemic and bleeding adverse effects. Peto odds ratios were computed. A total of 10 studies (7 randomized, 3 nonrandomized) were included, enrolling 1,567 patients (712 loaded with 300 mg, 11 with 450 mg, 790 with 600 mg, and 54 with 900 mg). Overall, a high loading dose proved significantly superior to a standard loading dose in preventing cardiac death or nonfatal myocardial infarction (odds ratio 0.54, 95% confidence interval 0.32 to 0.90, p = 0.02), without any statistically significant increase in major or minor bleedings (p = 0.55 and p = 0.98, respectively). Sensitivity analysis restricted to randomized trials confirmed the superiority of a high loading dose regimen (p = 0.0031). Meta-regression disclosed a significant interaction between event rate and the benefits of high loading doses (p = 0.005), suggesting that the greater the underlying risk, the greater the favorable impact of a high loading dose. In conclusion, a high clopidogrel loading dose (>300 mg) significantly reduces early ischemic events in patients scheduled for percutaneous coronary intervention.
AB - Full text: Meta-Analysis Appraising High Clopidogrel Loading in Patients Undergoing Percutaneous Coronary Intervention††Conflicts of interest: Dr. Angiolillo is a consultant and on the speaker's bureau for Bristol Myers Squibb, New York, New York, and Sanofi-Aventis, Paris, France. Dr. Biondi-Zoccai has consulted for Boston Scientific, Natick, Massachusetts, and Cordis, Miami, Florida. Combined antiplatelet treatment with aspirin and clopidogrel is pivotal to minimize periprocedural adverse events in patients who undergo percutaneous coronary intervention. However, there is debate on the best clopidogrel loading dose. The investigators performed a systematic review and meta-analysis of the optimal clopidogrel loading dose. Pertinent trials comparing high (>300 mg) and standard (300 mg) clopidogrel loading doses in patients scheduled for catheterization and/or percutaneous coronary intervention were systematically searched in BioMedCentral, CENTRAL, Google Scholar, and PubMed (December 2006). The primary end point was the 1-month rate of death or myocardial infarction. Secondary end points included other ischemic and bleeding adverse effects. Peto odds ratios were computed. A total of 10 studies (7 randomized, 3 nonrandomized) were included, enrolling 1,567 patients (712 loaded with 300 mg, 11 with 450 mg, 790 with 600 mg, and 54 with 900 mg). Overall, a high loading dose proved significantly superior to a standard loading dose in preventing cardiac death or nonfatal myocardial infarction (odds ratio 0.54, 95% confidence interval 0.32 to 0.90, p = 0.02), without any statistically significant increase in major or minor bleedings (p = 0.55 and p = 0.98, respectively). Sensitivity analysis restricted to randomized trials confirmed the superiority of a high loading dose regimen (p = 0.0031). Meta-regression disclosed a significant interaction between event rate and the benefits of high loading doses (p = 0.005), suggesting that the greater the underlying risk, the greater the favorable impact of a high loading dose. In conclusion, a high clopidogrel loading dose (>300 mg) significantly reduces early ischemic events in patients scheduled for percutaneous coronary intervention.
UR - http://www.scopus.com/inward/record.url?scp=34948852426&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34948852426&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2007.05.048
DO - 10.1016/j.amjcard.2007.05.048
M3 - Article
C2 - 17920357
AN - SCOPUS:34948852426
VL - 100
SP - 1199
EP - 1206
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 8
ER -