High Maintenance Dose Clopidogrel After PCI May Reduce Adverse Events

MedicalResearch.com Interview with:
Yan Liang, MD, PHD on behalf of co-authors

Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

Medical Research: What is the background for this study? What are the main findings?

Response: The background of this study is mainly derived from the results of CURRENT-OASIS7 which has shown a 7-day 150 mg maintenance dose (MD) clopidogrel could reduce cardiovascular events among subgroup patients undergoing percutaneous coronary intervention (PCI) compared with the 75 mg/day regimen. We conducted a meta-analysis based on 17 randomized controlled trials to determine whether prolonging the high MD clopidogrel (≥150 mg) treatment period to at least 4 weeks could reduce major adverse cardiac events (MACEs) in the PCI patients with and without high on-clopidogrel platelet reactivity (HPR).

Our study concluded that the high  maintenance dose clopidogrel was associated with a significant reduction in the risk of MACEs in PCI patients without increasing the rate of “Major/Minor bleeding” or “Any bleeding” in comparison with standard 75mg MD clopidogrel, and the “HPR Patients” subgroup were also benefited from such high MD treatment.

Medical Research: What should clinicians and patients take away from your report?

Response: First, recent guidelines recommend a 600mg loading dose clopidogrel followed by 75 mg/day MD at least for 1 year for PCI patients, while subacute or late thrombosis still occurs in 1-2% of these patients who might have inadequate antiplatelet effect during the maintenance phase, implying the need for a higher MD regimen.

Second, high on-clopidogrel platelet reactivity (HPR) has been associated with greater incidence of adverse events in PCI patients, and in these poor non-responders empirical shift to prasugrel or ticagrelor may increase the risk of bleeding since up to now we still do not have concrete evidence showing that new P2Y12 inhibitors benefit PCI patients with HPR better than clopidogrel. So, it remains to be meaningful to evaluated whether clopidogrel dose adjustments or a high MD clopidogrel provide a more favorable clinical outcome in such patients.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Further research into large prospective studies with long period treatment of high maintenance dose clopidogrel in PCI patients may be required to confirm our findings.

Citation:
Meta-Analysis Appraising High Maintenance Dose Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention with and without High On-Clopidogrel Platelet Reactivity 
Wenfang Ma, MD, Yan Liang, MD, PHD, Jun Zhu, MD, Yang Wang, MD, PHD, Xinjie Wang, MD
The American Journal of Cardiology

Available online 18 December 2014