Clopidogrel for Acute MI: 600 mg Beats 300 mg in a Randomized Trial

In a randomized study underpowered for clinical endpoints, mean infarct size was significantly smaller with the higher loading dose.

Guideline recommendations for a clopidogrel loading dose of 600 mg in patients with acute myocardial infarction (MI) are based on data from observational studies and extrapolated from randomized, controlled trial findings in patients undergoing nonurgent percutaneous coronary intervention (PCI). In this randomized, multicenter, European study, investigators compared a 600-mg loading dose of clopidogrel with a 300-mg dose in 201 patients undergoing primary PCI for ST-segment-elevation MI. Baseline patient and procedural characteristics were similar in the two dose groups.

The primary endpoint — infarct size measured by biomarker levels — was significantly reduced with the higher clopidogrel dose: Median total creatine kinase-myocardial band m…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI