Does reloading clopidogrel for patients with unstable angina who are on chronic clopidogrel therapy and undergoing percutaneous coronary intervention impact outcome?




Background


Previous data suggests that patients presenting with acute coronary syndrome (ACS) who are on chronic clopidogrel have a poor prognosis possibly due to low response to clopidogrel. This study aimed to evaluate whether there is additional benefit for reloading with clopidogrel on patients with unstable angina who are already on chronic clopidogrel therapy.




Methods


A cohort of 1499 patients on chronic clopidogrel therapy (>30 days) who presented with ACS without elevation of cardiac biomarkers were identified and were followed clinically till hospital discharge. Of these, 952 patients were reloaded and 547 patients were not reloaded and continued with chronic clopidogrel treatment of 75 mg/day. Clinical events were recorded and compared between the two groups. Patients with acute myocardial infarction (MI) were excluded. The decision to reload as well as timing and dosage of the reload was at the discretion of the operator.




Methods


A cohort of 1499 patients on chronic clopidogrel therapy (>30 days) who presented with ACS without elevation of cardiac biomarkers were identified and were followed clinically till hospital discharge. Of these, 952 patients were reloaded and 547 patients were not reloaded and continued with chronic clopidogrel treatment of 75 mg/day. Clinical events were recorded and compared between the two groups. Patients with acute myocardial infarction (MI) were excluded. The decision to reload as well as timing and dosage of the reload was at the discretion of the operator.




Results


The baseline characteristics of the groups were similar except higher history of coronary artery bypass graft surgery (CABG) and chronic renal insufficiency in the no-reload group. The no-reload group had higher usage of unfractionated heparin. Overall angiographic success was lower in the no-reload group, which also experienced higher bleeding rates and longer hospital stays. The in-hospital stent thrombosis rates and the major in-hospital complications (death, Q-wave MI, and CABG) rates were similar in both groups.

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Nov 16, 2017 | Posted by in CARDIOLOGY | Comments Off on Does reloading clopidogrel for patients with unstable angina who are on chronic clopidogrel therapy and undergoing percutaneous coronary intervention impact outcome?

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