CLINICAL STUDIES
Clopidogrel versus ticlopidine after intracoronary stent placement
Peter B. Berger, MD, FACC*,1,
Malcolm R. Bell, MB, BS, FACC*,
Charanjit S. Rihal, MD, FACC*,
Henry Ting, MD*,
Gregory Barsness, MD*,
Kirk Garratt, MD, FACC*,
Victoria Bellot, MD*,
Verghese Mathew, MD, FACC*,
Steve Melby, RN*,
LaVon Hammes*,
Diane Grill, MS and
David R. Holmes, Jr., MD, FACC*
* Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
Manuscript received May 7, 1999;
revised manuscript received June 29, 1999,
accepted August 27, 1999.
Reprint requests and correspondence: Dr. Peter Berger, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
OBJECTIVES
The study compared the safety and efficacy of ticlopidine with clopidogrel in patients receiving coronary stents.
BACKGROUND
Stent thrombosis is reduced when ticlopidine is administered with aspirin. Clopidogrel is similar to ticlopidine in chemical structure and function but has fewer side effects; few data are available about its use in stent patients.
METHODS
We compared 30-day event rates in 500 consecutive coronary stent patients treated with aspirin and clopidogrel (300 mg loading dose immediately prior to stent placement, and 75 mg/day for 14 days) to 827 consecutive stent patients treated with aspirin and ticlopidine (500 mg loading dose and 250 mg twice daily for 14 days).
RESULTS
Patients treated with clopidogrel had more adverse clinical characteristics including older age, more severe angina, and more frequent infarction within the prior 24 h. Nonetheless, mortality was 0.4% in clopidogrel patients versus 1.1% in ticlopidine patients; nonfatal myocardial infarction occurred in 0% versus 0.5%, stent thrombosis in 0.2% versus 0.7%, bypass surgery or repeat angioplasty in 0.4% versus 0.5%, and any event occurred in 0.8% versus 1.6% of patients, respectively (p = NS). Based on the observed 30-day event rate of 1.6% with ticlopidine, the statistical power of the study was 43% to detect an even rate of 0.5% with clopidogrel, and 75% to detect an event rate with of 4% with clopidogrel, with a p value of 0.05.
CONCLUSIONS
These data indicate that clopidogrel can be safely substituted for ticlopidine in patients receiving coronary stents.
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Abbreviations and Acronyms
| | ADP | = adenosine diphosphate | | CK | = creatine phosphokinase | | CK-MB | = creatine kinase–myocardial band | | TIMI | = Thrombolysis in Myocardial Infarction trial |
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|
|
|
|
|
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|
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|
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|
|
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|
|
|
|
|
|
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|
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|
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|
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|
|
|
|
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|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
U. Rauch, J. I. Osende, V. Fuster, J. J. Badimon, Z. Fayad, and J. H. Chesebro
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Ann Intern Med,
February 6, 2001;
134(3):
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|
|
|
|
|
|
|
C. Patrono, B. Coller, J. E. Dalen, G. A. FitzGerald, V. Fuster, M. Gent, J. Hirsh, and G. Roth
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January 1, 2001;
119(1_suppl):
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[Full Text]
[PDF]
|
|
|
|
|
|
|
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January 1, 2001;
119(1_suppl):
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[PDF]
|
|
|
|
|
|
|
P.J. De Feyter and D. Foley
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Eur. Heart J.,
November 1, 2000;
21(21):
1719 - 1726.
[PDF]
|
|
|
|
|
|
|
F. L. Paradiso-Hardy, C. M. Angelo, K. L. Lanctot, and E. A. Cohen
Hematologic dyscrasia associated with ticlopidine therapy: evidence for causality
Can. Med. Assoc. J.,
November 1, 2000;
163(11):
1441 - 1448.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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October 11, 2000;
284(14):
1828 - 1836.
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[Full Text]
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|
|
|
|
|
|
|
R. S. Dieter
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J. Am. Coll. Cardiol.,
October 1, 2000;
36(4):
1436 - 1436.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Helft, J. I. Osende, S. G. Worthley, A. G. Zaman, O. J. Rodriguez, E. I. Lev, M. E. Farkouh, V. Fuster, J. J. Badimon, and J. H. Chesebro
Acute Antithrombotic Effect of a Front-Loaded Regimen of Clopidogrel in Patients With Atherosclerosis on Aspirin
Arterioscler. Thromb. Vasc. Biol.,
October 1, 2000;
20(10):
2316 - 2321.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Moshfegh, M. Redondo, F. Julmy, W. A. Wuillemin, M. U. Gebauer, A. Haeberli, and B. J. Meyer
Antiplatelet effects of clopidogrel compared with aspirin after myocardial infarction: enhanced inhibitory effects of combination therapy
J. Am. Coll. Cardiol.,
September 1, 2000;
36(3):
699 - 705.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. W. Klein and J. E. Calvin
Use of clopidrogel in coronary stenting: what was the question?
J. Am. Coll. Cardiol.,
December 1, 1999;
34(7):
1895 - 1898.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. C. Lowe, R. G. Fahmy, M. M. Kavurma, A. Baker, C. N. Chesterman, and L. M. Khachigian
Catalytic Oligodeoxynucleotides Define a Key Regulatory Role for Early Growth Response Factor-1 in the Porcine Model of Coronary In-Stent Restenosis
Circ. Res.,
October 12, 2001;
89(8):
670 - 677.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
