Research shows that using antiplatelet medication called clopidogrel before coronary angioplasty surgery often reduces the risk of death from cardiovascular problems like heart attacks, or strokes. The research paper was published in the latest issue of JAMA.
Dual antiplatelet therapy following percutaneous coronary intervention using a combination of drugs such as ticlopidine or clopidogrel along with aspirin helps reduce platelet activation and thrombotic and ischemic complications. However, the optimal timing of the initiation of clopidogrel has been debated. The benefit of clopidogrel pretreatment started hours to days before PCI compared with treatment given at the time of PCI in high-risk patients with acute coronary syndromes remains incompletely defined, and current guidelines do not universally recommend pretreatment.
Researchers from Harvard Medical School, Boston, had conducted a study to determine if clopidogrel pretreatment hours to days before PCI is superior to clopidogrel treatment initiated at the time of PCI in preventing major adverse cardiovascular events in patients undergoing PCI after initial pharmacological therapy for ST-segment elevation myocardial infarction.
The study included an analysis of 1,863 patients undergoing PCI after mandated angiography for STEMI. Patients received aspirin and were randomized to receive either clopidogrel (300 mg loading dose [a comparatively large dose given at the beginning of treatment to start getting the effect of a drug more quickly], then 75 mg once daily) or placebo initiated with fibrinolysis and given until coronary angiography, which was performed 2 to 8 days after initiation of the study drug.
The researchers found that pretreatment with clopidogrel significantly reduced by 46 percent the odds of cardiovascular death, heart attack, or stroke following PCI (34 events [3.6 percent] vs. 58 events [6.2 percent].
Pretreatment with clopidogrel also reduced the odds by 38 percent of heart attack or stroke prior to PCI (37 [4.0 percent] vs. 58 [6.2 percent]. Overall, pretreatment with clopidogrel resulted in a 41 percent reduction in the odds of cardiovascular death, heart attack, or stroke from randomization through 30 days.