title: Meta-analysis appraising high clopidogrel loading in patients undergoing percutaneous coronary intervention.
abstract: Combined antiplatelet treatment with aspirin and clopidogrel is pivotal to minimize periprocedural adverse events in patients who undergo percutaneous coronary intervention. However, there is debate on the best clopidogrel loading dose. The investigators performed a systematic review and meta-analysis of the optimal clopidogrel loading dose. Pertinent trials comparing high (>300 mg) and standard (300 mg) clopidogrel loading doses in patients scheduled for catheterization and/or percutaneous coronary intervention were systematically searched in BioMedCentral, CENTRAL, Google Scholar, and PubMed (December 2006). The primary end point was the 1-month rate of death or myocardial infarction. Secondary end points included other ischemic and bleeding adverse effects. Peto odds ratios were computed. A total of 10 studies (7 randomized, 3 nonrandomized) were included, enrolling 1,567 patients (712 loaded with 300 mg, 11 with 450 mg, 790 with 600 mg, and 54 with 900 mg). Overall, a high loading dose proved significantly superior to a standard loading dose in preventing cardiac death or nonfatal myocardial infarction (odds ratio 0.54, 95% confidence interval 0.32 to 0.90, p = 0.02), without any statistically significant increase in major or minor bleedings (p = 0.55 and p = 0.98, respectively). Sensitivity analysis restricted to randomized trials confirmed the superiority of a high loading dose regimen (p = 0.0031). Meta-regression disclosed a significant interaction between event rate and the benefits of high loading doses (p = 0.005), suggesting that the greater the underlying risk, the greater the favorable impact of a high loading dose. In conclusion, a high clopidogrel loading dose (>300 mg) significantly reduces early ischemic events in patients scheduled for percutaneous coronary intervention.
authors.affiliation: Institute of Cardiology, Catholic University, Rome, Italy.
authors.forename: Marzia
authors.initials: M
authors.lastname: Lotrionte
authors.forename: Giuseppe G L
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Abbate
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Emanuele
authors.initials: E
authors.lastname: Meliga
authors.forename: Thomas
authors.initials: T
authors.lastname: Cuisset
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Alessi
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.forename: Germano
authors.initials: G
authors.lastname: Di Sciascio
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sangiorgi
authors.forename: Antonio
authors.initials: A
authors.lastname: Laudito
authors.forename: Gian P
authors.initials: GP
authors.lastname: Trevi
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000008:administration & dosage*; D000077144:Clopidogrel; D023921:Coronary Stenosis / Q000473:pathology / Q000628:therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin