title: Influence of treatment duration with a 600-mg dose of clopidogrel before percutaneous coronary revascularization.
abstract: OBJECTIVE
  We examined clinical outcomes in the Intracoronary Stenting and Antithrombotic Regimen-Rapid Early Action for Coronary Treatment (ISAR-REACT) trial based on the duration of pretreatment with a 600-mg loading dose of clopidogrel.
  
  
  BACKGROUND
  The influence of the treatment duration with a 600-mg dose of clopidogrel before percutaneous coronary revascularization on early outcomes remains uncertain.
  
  
  METHODS
  Among 2,159 patients with coronary disease who underwent percutaneous coronary intervention (PCI) in the ISAR-REACT trial, we examined clinical outcomes relative to the duration of pretreatment with a 600-mg dose of clopidogrel: (2 to 3 h, 3 to 6 h, 6 to 12 h, or >12 h). Patients were randomly assigned to adjunctive therapy with abciximab or placebo at the beginning of the study. The primary end point was a composite of death, myocardial infarction, or urgent revascularization within 30 days after randomization.
  
  
  RESULTS
  No significant differences were observed between patient groups regarding the duration of pretreatment, irrespective of assignment to abciximab or placebo (p = 0.27 for interaction among abciximab/clopidogrel and placebo/clopidogrel treatment at each time interval). Occurrence of major bleeding also did not differ according to time of initial clopidogrel dosing.
  
  
  CONCLUSIONS
  For low-to-intermediate risk patients treated with a 600-mg loading dose of clopidogrel before PCI, incremental clinical benefit within the first 30 days from durations of pretreatment >2 to 3 h was not evident.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina, USA. kandz002@mc.duke.edu
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
authors.forename: Steven R
authors.initials: SR
authors.lastname: Steinhubl
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
authors.forename: Franz
authors.initials: F
authors.lastname: Dotzer
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: Ten Berg
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.forename: Hildegard
authors.initials: H
authors.lastname: Bollwein
authors.forename: Josef
authors.initials: J
authors.lastname: Dirschinger
authors.forename: Albert
authors.initials: A
authors.lastname: Schömig
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000077144:Clopidogrel; D003327:Coronary Disease / Q000188:drug therapy / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D013988:Ticlopidine / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077144:Clopidogrel; D013988:Ticlopidine; D000077284:Abciximab