| Summary: | 碩士 === 國立成功大學 === 臨床藥學研究所 === 95 === Background/ Aims: Clopidogrel 300mg loading dose has been shown to benefit patients who undergo percutaneous coronary intervention (PCI) after short-term or long -term follow up in big clinical trials. Guidelines either in American College of Cardiology/American Heart Association (ACC/AHA) or European Society of Cardiology (ESC) recommend the 300mg loading dose clopidogrel combined with aspirin in PCI patients for better prognosis. But those recommendations were limited in heterogeneous procedures, including stenting, balloon angioplasty, etc., the accurate efficacy and safety profile in stent-implanted patients are unknown. Besides, in real world practice, there are still other prescriptions, such as 75mg clopidogrel per day either before or after the procedures, or 300mg loading dose clopidogrel given after the procedures. To the best of our knowledge, the clinical effects of the recommended dose are not well-known in Taiwan.This study aimed to compare the outcome benefits among all regimens in stent-implanted patients who had stable coronary artery disease or acute coronary syndrome.
Methods: Patients who had their stent implantation during 2002-2006 were recruited in this study, but the one using ticlopidine or didn’t receive dual antiplatelet therapy will be excluded. All data are collected retrospectively by chart review. 606 eligible subjects were included and divided into two groups: pretreatment and post-treatment group. The observed endpoints are cardiovascular death, nonfatal myocardio infarction, target vessel revascularization, stroke, unstable angina, during one year follow-up. Also, the bleeding complications were recorded.
Results: There were no significant differences between regimens neither in 30-day nor 1 year follow-up. But it had the trend towarding lower cardiac events in the pretreatment clopidogrel loading group, especially in the ST elevation myocardial infarction patients (when compared with post-treatment clopidogrel loading dose group). Parameters included in the Cox proportional hazard regression model that independently associated with any cardiovascular events in 30 days was the duration of clopidogrel after stent implantation (HR 0.892, CI 0.822-0.969, p=0.0006), the longer the duration, the lower the risk, either in bare metal stent or drug eluting stent pateints. And parameters that independently associated with any cardiovascular events in 1 year, was the Killip classification IV (All regimen: HR 17.825, CI 5.054-62.864, p<0.001; only loading dose included: HR 68.629, CI 6.394-736.632, p<0.001).
Conclusion: In this study, there was no statistically significant risk reduction in the pretreatment loading dose group, but it has the trend towarding the lower event rate while other regimens had similar outcomes. We also recommend that stent-implanted patients, either bare metal stent or drug eluting stent patients, should complete the usage of 1-month clopidogrel.
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