Clopidogrel Reloading Does Not Provide Additional Benefit in Patients Presenting with ACS

NEW ORLEANS, LA—Chronic clopidogrel therapy (CCT) in patients who present with acute coronary syndrome (ACS) have similar in-hospital outcomes regardless of clopidogrel reloading. Investigators presented data at ACC.11, the American College of Cardiology's 60th Annual Scientific session, that demonstrated that clopidogrel reloading, although safe, does not impact in-hospital or long-term clinical events.

A low response to clopidogrel may be the underlying reason for the poor prognosis of patients on CCT who present with ACS. Large randomized studies evaluating clopidogrel reloading are lacking. Asmir I. Syed, MD from the Washington Hospital Center, Washington, DC, and colleagues aimed to evaluate whether there is additional benefit of reloading with clopidogrel in patients who present with ACS while on CCT and undergoing percutaneous coronary intervention (PCI).

A cohort of 2,137 patients on CCT (>5 days) who presented with ACS and received at least one stent were identified and followed clinically up to 1 year. A total of 1,334 patients were reloaded with ≥300mg clopidogrel; 803 patients were not reloaded. All patients continued CCT 75mg/day in addition to aspirin. The decision to reload was at the discretion of the operator. Excluded patients had cardiogenic shock and vein graft intervention.

The baseline characteristics were similar, except the no-reload group were older, had more vascular and renal disease, and heparin use. The composite major in-hospital complications and in-hospital bleeding rates (major and minor) were similar. Major adverse cardiac events (MACE) (death, myocardial infarction [MI], or tricuspid valve replacement [TVR]) at 1 year were similar in both groups even after adjustment of differences in baseline characteristics (HR=0.83 [0.57–1.22]; P=0.351). See Table.