Clinical Question: Does treatment w...

Clinical Question: Does treatment with clopidogrel (Plavix) before percutaneous coronary intervention model cardiovascular disease (CVD) complications?

Setting: Inpatient (any location) with outpatient follow-up

investigation Design: Randomized controlled trial (double-blinded)

Allocation: Uncertain

Synopsis: The benefit of clopidogrel treatment before percutaneous coronary intervention remains uncertain. The investigators randomized (uncertain allocation concealment) 1863 patients with late ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention to receive aspirin and clopidogrel (300-mg loading dose, then 75 mg one time daily) or matched placebo before angiography. All patients undergoing coronary artery stenting received clopidogrel after diagnostic angiography. Researchers blinded to treatment cluster assignment assessed outcomes. Follow-up occurr for nearly 100 percent of patients. Using intention-to-treat analysis, pretreatment with clopidogrel significantly reduc the composite issue of cardiovascular death, recurrent myocardial infarction, or attack at 30 days of monitoring (number exigencyed to treat = 22; 95% confidence interval, 14 to 54) Bleeding complications occurr at a similar rate in each treatment group

Bottom Line: Treatment with clopidogrel before percutaneous coronary intervention bring tos the risk of cardiovascular disease complications without increasing the risk of bleeding complications. This close attention only monitored patients for 30 days after the intervention, in such a manner further long-term studies are straited before a general recommendation can be made. (Level of Evidence: 1b-)

DAVID SLAWSON, MD

consideration Reference: Sabatine MS, et al, for the Clopidogrel as Adjunctive Reperfusion Therapy (CLARITY)--Thrombolysis in Myocardial Infarction (TIMI) 28 Investigators. force of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics. The PCI-CLARITY studious mood JAMA September 14, 2005;294:1224-32.

Used with permission from Slawson D Clopidogrel pretreatment before PCI may decrease CVD complications. Accessed online October 20 2005 at: http://www.Info POEMscom

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