Adding clopidogrel to aspirin improves outcome in ST-elevation myocardial infarction patients receiving fibrinolytic therapy.
Acute coronary syndromes result from the rupture of an atherosclerotic plaque with superimposed thrombosis. In an ST-elevation myocardial infarction, the thrombus occludes the coronary vessel, leading to an abrupt decrease in myocardial perfusion. The focus of initial management is the timely restoration of flow in the infarct-related artery via fibrinolytic therapy or percutaneous coronary intervention. Adjunctive therapy aimed at inhibition of platelets and the coagulation cascade is critical to establish and maintain vessel patency. Clopidogrel, an oral antiplatelet agent, has recently been shown to offer significant clinical benefit in STEMI (ST-elevation myocardial infarction) and is a welcome addition to standard fibrinolytic therapy.
Donahoe
Sean M
SM
Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. sdonahoe@partners.org
Sabatine
Marc S
MS