title: Comparison of efficacy and safety of a standard versus a loading dose of clopidogrel for acute myocardial infarction in patients ≥ 75 years of age (from the FAST-MI registry).
abstract: Data are lacking on the efficacy and safety of a loading dose (LD) of clopidogrel in elderly patients with acute myocardial infarction (AMI). FAST-MI is a nationwide registry that was carried out over a 1-month period in 2005 and included consecutive patients with AMI admitted to intensive care units <48 hours from symptom onset in 223 participating centers. We assessed the impact of a clopidogrel LD (≥300 mg) compared to a conventional dose (<300 mg) on bleeding, need for blood transfusion, and 30-day and 12-month survivals in 791 elderly patients (≥75 years old, mean age 81 ± 4 years, 48% women, 35% with ST-segment elevation MI) included in this registry. Fifty-nine percent (466 patients) received a clopidogrel LD. Follow-up was >99% complete. Major bleeding and blood transfusions were not significantly different in patients who received a clopidogrel LD (3.2% vs 3.7%, p = 0.72; 5.4% vs 6.2%, p = 0.64, respectively). Early mortality was also not significantly different (10.1 vs 10.8, p = 0.76). Using multivariate analyses, clopidogrel LD did not significantly affect major bleeding or transfusion (odds ratio 1.03, 95% confidence interval 0.49 to 2.17, p = 0.94) and 12-month mortality (hazard ratio 1.00, 95% confidence interval 0.72 to 1.40, p = 0.98). In conclusion, the present data showed that in elderly patients admitted for AMI, use of a LD of clopidogrel compared to a conventional dose was not associated with increased in-hospital bleeding, need for transfusion, or mortality. Large-scale randomized trials are still needed to identify the optimal LD of clopidogrel for elderly patients admitted for AMI.
authors: Division of Coronary Artery Disease and Intensive Cardiac Care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France. etiennepuymirat@yahoo.fr
authors: Etienne
authors: E
authors: Puymirat
authors: Nadia
authors: N
authors: Aïssaoui
authors: Pierre
authors: P
authors: Coste
authors: Gilles
authors: G
authors: Dentan
authors: Vincent
authors: V
authors: Bataille
authors: Elodie
authors: E
authors: Drouet
authors: Geneviève
authors: G
authors: Mulak
authors: Dider
authors: D
authors: Carrié
authors: Didier
authors: D
authors: Blanchard
authors: Tabassome
authors: T
authors: Simon
authors: Nicolas
authors: N
authors: Danchin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001803:Blood Transfusion / Q000706:statistics & numerical data; D000077144:Clopidogrel; D005260:Female; D005602:France / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine