LETTER TO THE EDITOR
Clopidogrel versus ticlopidine after the placement of coronary artery stents
David Rott, MD
The Heiden Department of Cardiology, Bikur-Cholim Hospital, 5 Strauss St., Jerusalem 91004, Israel
drott{at}012.net.il
In a study published recently in JACC, Mueller et al. (1) compared treatment with clopidogrel and aspirin to ticlopidine and aspirin in patients undergoing coronary stent placement. Both drugs were started after the procedure and continued for four weeks. Ticlopidine was given as a 500-mg loading dose followed by 250 mg twice daily thereafter; however, clopidogrel was given without loading: 75 mg daily. The results suggested that clopidogrel was inferior to ticlopidine in terms of cardiovascular mortality. In other studies involving clopidogrel, a loading dose of 300 mg was given initially followed by 75 mg daily thereafter (2,3). A loading dose of 300 mg of clopidogrel is needed in order to achieve timely platelet inhibitory effect (4). The lack of clopidogrel loading clearly delays the effect of clopidogrel and, therefore, may cause a higher thrombotic stent occlusion (TSO) rate (the TSO rate was not reported by Mueller et al.). Use of a clopidogrel loading dose in this instance may show clopidogrel not to be inferior to ticlopidine (3).
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References
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1. Mueller C, Roskamm H, Neumann FJ. A randomized comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary artery stents. J Am Coll Cardiol. 2003;41:969–973[Abstract/Free Full Text]
2. Mehta SR, Yusuf S, Peters RJ, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001;358:527–533[CrossRef][Medline]
3. Atmaca Y, Dandachi R, Gulec S, Dincer I, Oral D. Comparison of clopidogrel versus ticlopidine for prevention of minor myocardial injury after elective coronary stenting. Int J Cardiol. 2003;87:143–149[CrossRef][Medline]
4. Gurbel PA, Cummings CC, Bell CR, et al. Onset and extent of platelet inhibition by clopidogrel loading in patients undergoing elective coronary stenting: the Plavix Reduction Of New Thrombus Occurrence (PRONTO) trial. Am Heart J. 2003;145:239–247[CrossRef][Medline]
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