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(Circulation. 2008;118:1219-1222.)
© 2008 American Heart Association, Inc.

Editorial

What to Do With Patients Receiving Long-Term Clopidogrel

Reload or Relax?

David O. Williams, MD; J. Dawn Abbott, MD

From the Division of Cardiology, Department of Medicine, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI.

Correspondence to David O. Williams, MD, APC 814, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903. E-mail dowilliams@lifespan.org

Key Words: Editorials • angioplasty • antiplatelet agents • clopidogrel • stents • thrombosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

It is difficult to recall a drug whose first dose has received as much attention as clopidogrel. Indeed, the current Clopidogrel Optimal Dose Usage to Reduce Recurrent Events (CURRENT-OASIS 7) clinical trial hopes to enroll 14 000 patients with acute coronary syndromes treated via invasive strategies to determine whether an initial 600-mg loading dose (LD) followed by 150 mg/d of clopidogrel for 1 week and 75 mg/d thereafter is superior to a 300-mg LD and a subsequent 75 mg/d dose. The basis for such a trial is to identify the dose of clopidogrel that will achieve rapid and maximal inhibition of platelet aggregation (IPA) in order to minimize the occurrence of spontaneous or procedural-related coronary thrombosis and have an acceptable incidence of significant bleeding.

Article p 1225

Several reports have demonstrated that as compared with a 300-mg LD, a dose of 600 mg results in an earlier onset of inhibitory effect and substantially greater IPA, which results in a smaller proportion of clopidogrel "nonresponders" and patients with high posttreatment platelet reactivity.^1,2 Furthermore, at least 2 randomized clinical trials have demonstrated improved clinical outcomes with a clopidogrel LD >300 mg. In the Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty (ARMYDA-2) trial, elective percutaneous coronary intervention (PCI) patients receiving pretreatment with a 600-mg LD of clopidogrel experienced fewer periprocedural myocardial infarctions than those treated with 300 mg clopidogrel, resulting in superior 30-day outcomes.³ In higher-risk PCI patients with non-ST-segment elevation acute coronary syndromes, a 600-mg LD of clopidogrel was superior . . . [Full Text of this Article]