Two Clopidogrel Loading Doses Compared in Patients with STEMI

Patients with STEMI who underwent primary PCI had better clinical outcomes — and no greater risk for bleeding — with a 600-mg loading dose compared with 300 mg.

Given that platelet inhibition during percutaneous coronary intervention is more rapid and complete when a 600-mg loading dose of clopidogrel is used, it is often preferred over a 300-mg dose, both for PCI with stenting and in acute coronary syndrome patients who undergo PCI. Now, using data from the HORIZONS-AMI trial (JW Cardiol May 21 2008), investigators have compared outcomes in patients with ST-segment-elevation MI who received a 300-mg (1153 patients) or a 600-mg (2158 patients) loading dose of clopidogrel before being randomized either to bivalirudin alone or to unfractionated heparin plus a glycoprotein (GP) IIb/IIIa inhibitor.

For each of the 30-day endpoints — death, reinfarction, major adverse cardiovascular events, and major ble…

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