Journal article
Outcome Comparison of 600 mg versus 300 mg Loading dose of Clopidogrel for Patients with ST-Elevation Myocardial Infarction: A Meta-Analysis
Postgraduate medicine, Vol.126(5), pp.177-187
09/01/2014
DOI: 10.3810/pgm.2014.09.2812
PMID: 25295662
Abstract
Background: A 600-mg loading dose (LD) of clopidogrel has been shown to be superior to a 300-mg LD in inhibiting platelet function. However, data for clinical superiority are limited, and there is a paucity of adequately powered randomized trials investigating this issue. This meta-analysis was performed to determine the optimal LD of clopidogrel in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention. Methods: A meta-analysis of controlled trials and observational studies was performed comparing 600-mg with 300-mg LDs of clopidogrel. The primary efficacy end point was a major adverse cardiac event (MACE), and the primary safety end point was major bleeding. Data were extracted on an intention to treat basis. The X
2
test was used to evaluate heterogeneity. A random effects model was used, and odds ratios (OR) were calculated using the Mantel-Haenszel method. Results: Nine studies involving 18 623 patients were included in the efficacy analysis. Mean duration of follow-up was 8 months. Four studies were eligible for the safety analysis. The MACE risk was lower with a 600-mg LD (7.0% [650/9231]) than with a 300-mg LD (9.2% [867/9392]; OR, 0.75; 95% CI, 0.63-0.91). On the other hand, there was no significant difference in the major bleeding events between the 2 groups (2.5% [89/3551] with 600 mg vs 2.3% [63/2796] with 300 mg; OR, 0.84; 95% CI, (0.60-1.16). Conclusions: In ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention, administration of a 600-mg LD of clopidogrel is associated with a lower risk of MACE than is administration of a 300-mg LD, without increasing the risk of major bleeding.
Details
- Title: Subtitle
- Outcome Comparison of 600 mg versus 300 mg Loading dose of Clopidogrel for Patients with ST-Elevation Myocardial Infarction: A Meta-Analysis
- Creators
- Ankur VyasRamzi N El AccaouiAmy BlevinsWassef Karrowni
- Resource Type
- Journal article
- Publication Details
- Postgraduate medicine, Vol.126(5), pp.177-187
- Publisher
- Taylor & Francis
- DOI
- 10.3810/pgm.2014.09.2812
- PMID
- 25295662
- ISSN
- 0032-5481
- eISSN
- 1941-9260
- Language
- English
- Date published
- 09/01/2014
- Academic Unit
- Radiology; Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984094358602771
Metrics
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