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CLINICAL STUDIES

Clopidogrel as adjunctive antiplatelet therapy during coronary stenting

^a Prairie Educational and Research Cooperative, Division of Cardiology, Southern Illinois University School of Medicine, Springfield, Illinois, USA

Manuscript received April 2, 1999; revised manuscript received July 27, 1999, accepted August 27, 1999.

Reprint requests and correspondence: Dr. Gregory J. Mishkel, Prairie Cardiovascular Consultants, Ltd., P.O. Box 19420, Springfield, Illinois 62794-9420
pccl{at}fgi.net

OBJECTIVES

We examined the procedural and 30-day clinical outcomes among patients receiving aspirin and either ticlopidine or clopidogrel during coronary stenting.

BACKGROUND

Ticlopidine-plus-aspirin has become standard antiplatelet therapy for the prevention of thrombotic complications after coronary stenting. Clopidogrel has a similar mechanism of action as ticlopidine, but both its efficacy and its safety as a pharmacologic adjunct to coronary stenting have not been well described.

METHODS

This single-center, prospective analysis examined the in-hospital procedural and 30-day clinical outcomes among 875 consecutive patients undergoing coronary stenting who received adjunctive aspirin and either clopidogrel (n = 514; 58.7%) or ticlopidine (n = 361; 41.3%) therapy.

RESULTS

Procedural success rates were similar among the clopidogrel- (99.6%) and ticlopidine-treated patients (99.4%). Subacute stent thrombosis (i.e., >24 h 30 days) occurred in one clopidogrel-treated (0.2%) and in one ticlopidine-treated (0.3%) patient (p = 0.99). By 30 days following the index procedure, the combined rates of death, nonfatal myocardial infarction and need for target vessel revascularization were similar among patients who received either clopidogrel (2.1%) or ticlopidine (1.4%; p = 0.57) therapy.

CONCLUSIONS

In this analysis the antiplatelet combination therapy of aspirin-plus-clopidogrel was an effective regimen for preventing thrombotic complications and major adverse cardiovascular events among a broad spectrum of patients undergoing coronary artery stenting.

Abbreviations and Acronyms   ACT = activated clotting time   AST = acute stent thrombosis   CABG = coronary artery bypass grafting   CK = creatinine kinase   GPIIb/IIIa = glycoprotein IIb/IIIa inhibitor   MACE = major adverse cardiac event   MI = myocardial infarction   PCI = percutaneous coronary intervention   SST = subacute stent thrombosis   TVR = target vessel revascularization

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