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To the Editor: Dr Steinhubl and colleagues¹ evaluated the effects of long-term treatment with clopidogrel and the benefit of a preprocedural loading dose in patients undergoing percutaneous coronary intervention (PCI). They reported that patients had better 1-year outcomes if they were treated with clopidogrel in addition to aspirin. I have several concerns about their study.

Patients treated with clopidogrel received a 300-mg loading dose before PCI, followed by a daily dose of 75 mg. In contrast, control patients received 75 mg/d of clopidogrel only after PCI and continued for 1 month. After 28 days, there were no statistically significant differences in end points between the treatment and control groups. In a prespecified subgroup analysis, a trend toward better outcomes was found if clopidogrel was administered 6 to 24 hours before PCI, but not if it was given between 3 to 6 hours before PCI. However, patients were not randomized with . . . [Full Text of this Article]

Robin P. Choudhury, MA, DM, MRCP
Department of Cardiovascular Medicine
University of Oxford
Oxford, England

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