HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mehta, S. R. Articles by Yusuf, S. Search for Related Content PubMed Articles by Mehta, S. R. Articles by Yusuf, S.

Short- and long-term oral antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention

^* Division of Cardiology, McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada

Manuscript received July 9, 2002; accepted August 19, 2002.

^* Reprint requests and correspondence: Dr. Shamir R. Mehta, Hamilton Health Sciences, General Division, McMaster Clinic, 237 Barton Street East, Hamilton, Ontario, Canada, L8L 2X2.
smehta{at}mcmaster.ca

Platelets play a central role in both the short- and long-term manifestations of atherothrombosis. In acute coronary syndrome (ACS), there is a steep rise in cardiovascular events early, followed by an incremental rise in cardiovascular events over the long term. This long-term event rate is related to persistent platelet activation and thrombin generation. There is therefore a need to optimize both short- and long-term oral antiplatelet and antithrombotic strategies. The benefits of aspirin therapy, when administered early and continued over the long term, were demonstrated in several early randomized trials. The Antithrombotic Trialists’ Collaboration found a 46% reduction in vascular events with antiplatelet therapy (mostly aspirin). However, despite treatment with aspirin and proven therapies, recurrent events remain high. The adenosine diphosphate receptor antagonists, ticlopidine and clopidogrel, inhibit the early steps of platelet activation, degranulation, and release of prothrombotic and inflammatory mediators, while also preventing activation of the glycoprotein IIb/IIIa receptor. The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial demonstrated the benefits of aspirin plus clopidogrel in reducing major cardiovascular events (cardiovascular death, myocardial infarction [MI], and stroke reduced by 20%, p = 0.00009) in a broad range of patients with ACS when administered early and continued over the long term. The benefits emerge very rapidly after a 300 mg loading dose. For the large number of patients undergoing percutaneous coronary intervention in the CURE trial, there was a substantial risk reduction with clopidogrel pretreatment followed by long-term therapy (p < 0.002). This benefit was present, regardless of whether intervention was performed early or late. The significant benefits of aspirin and clopidogrel persist for the combined efficacy-safety end point of cardiovascular death, MI, stroke, or life-threatening bleeding when clopidogrel is started early, combined with aspirin and other standard therapies, and continued for up to one year.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   ACS = acute coronary syndrome(s)   ADP = adenosine diphosphate   CABG = coronary artery bypass graft   GP = glycoprotein   MI = myocardial infarction   NSTE = non–ST-segment elevation   PCI = percutaneous coronary intervention   PTCA = percutaneous transluminal coronary angioplasty   RR = risk reduction

This article has been cited by other articles:

				J. E. Novak and L. A. Szczech Feast and Famine: Epidemiology and Clinical Trials in Chronic Kidney Disease J. Am. Soc. Nephrol., January 1, 2008; 19(1): 2 - 4. [Full Text] [PDF]

				S. D. Wiviott, E. Braunwald, C. H. McCabe, G. Montalescot, W. Ruzyllo, S. Gottlieb, F.-J. Neumann, D. Ardissino, S. De Servi, S. A. Murphy, et al. Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndromes N. Engl. J. Med., November 15, 2007; 357(20): 2001 - 2015. [Abstract] [Full Text] [PDF]

				P. P. Karjalainen, P. Porela, A. Ylitalo, S. Vikman, K. Nyman, M.-A. Vaittinen, T. J. Airaksinen, M. Niemela, T. Vahlberg, and K.E. J. Airaksinen Safety and efficacy of combined antiplatelet-warfarin therapy after coronary stenting Eur. Heart J., March 2, 2007; 28(6): 726 - 732. [Abstract] [Full Text] [PDF]

				S J Walsh, M S Spence, D Crossman, and A A J Adgey Clopidogrel in non-ST segment elevation acute coronary syndromes: an overview of the submission by the British Cardiac Society and the Royal College of Physicians of London to the National Institute for Clinical Excellence, and beyond Heart, September 1, 2005; 91(9): 1135 - 1140. [Abstract] [Full Text] [PDF]

				A. Schomig, C. Schmitt, A. Dibra, J. Mehilli, C. Volmer, H. Schuhlen, J. Dirschinger, F. Dotzer, J. M. ten Berg, F.-J. Neumann, et al. One year outcomes with abciximab vs. placebo during percutaneous coronary intervention after pre-treatment with clopidogrel Eur. Heart J., July 2, 2005; 26(14): 1379 - 1384. [Abstract] [Full Text] [PDF]

				R. Altman, A. Scazziota, S. Santoro, and C. Gonzalez Abciximab Does Not Inhibit the Increase of Thrombin Generation Produced in Platelet-Rich Plasma In Vitro by Sodium Arachidonate or Tissue Factor Clinical and Applied Thrombosis/Hemostasis, July 1, 2005; 11(3): 271 - 277. [Abstract] [PDF]

				S. Sanderson, J. Emery, T. Baglin, and A.-L. Kinmonth Narrative Review: Aspirin Resistance and Its Clinical Implications Ann Intern Med, March 1, 2005; 142(5): 370 - 380. [Abstract] [Full Text] [PDF]

				D. S. Cox, N. S. Kleiman, D. A. Boyle, J. Aluri, L. G. Parchman, F. Holdbrook, and M. J. Fossler Pharmacokinetics and Pharmacodynamics of Argatroban in Combination With a Platelet Glycoprotein IIB/IIIA Receptor Antagonist in Patients Undergoing Percutaneous Coronary Intervention J. Clin. Pharmacol., September 1, 2004; 44(9): 981 - 990. [Abstract] [Full Text] [PDF]

				M. Valgimigli, G. Percoco, D. Barbieri, F. Ferrari, G. Guardigli, G. Parrinello, O. Soukhomovskaia, and R. Ferrari The additive value of tirofiban administered with the high-dose bolus in the prevention of ischemic complications during high-risk coronary angioplasty: The advance trial J. Am. Coll. Cardiol., July 7, 2004; 44(1): 14 - 19. [Abstract] [Full Text] [PDF]

				J. Lorrain, I. Lechaire, C. Gauffeny, R. Masson, N. Roome, J.-P. Herault, S. E. O'Connor, P. Schaeffer, and J.-M. Herbert Effects of SanOrg123781A, a Synthetic Hexadecasaccharide, in a Mouse Model of Electrically Induced Carotid Artery Injury: Synergism with the Antiplatelet Agent Clopidogrel J. Pharmacol. Exp. Ther., April 1, 2004; 309(1): 235 - 240. [Abstract] [Full Text]