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Clopidogrel for Percutaneous Coronary Revascularization
Time for More Pretreatment, Retreatment, or Both?
David J. Moliterno, MD;
Steven R. Steinhubl, MD
JAMA. 2005;294:1271-1273.
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Antiplatelet agents—aspirin, thienopyridines, and glycoprotein IIb/IIIa (GpIIb/IIIa) inhibitors—have become cornerstones in the treatment of ischemic heart disease for patients with acute coronary syndrome (ACS) and for those undergoing percutaneous coronary intervention (PCI). Depending on the clinical scenario and the concomitant anticoagulants used, regimens combining 2 or more of these antiplatelet agents have resulted in fewer ischemic events and sometimes more bleeding events compared with aspirin alone. In patients with ST-segment elevation myocardial infarction (STEMI), aspirin has been shown to safely reduce mortality vs placebo,1 and it therefore serves a foundational role in thrombolytic therapy regimens. The addition of the most potent platelet aggregation inhibitors, GpIIb/IIIa receptor antagonists, to thrombolytic therapy (aspirin, heparin, and a fibrinolytic agent) in STEMI patients has not resulted in lower mortality rates but has reduced reinfarction rates. A meta-analysis of randomized trials testing abciximab (a GpIIb/IIIa inhibitor) among . . . [Full Text of this Article]
Author Affiliations: Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington.
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Marc S. Sabatine, Christopher P. Cannon, C. Michael Gibson, Jose L. López-Sendón, Gilles Montalescot, Pierre Theroux, Basil S. Lewis, Sabina A. Murphy, Carolyn H. McCabe, Eugene Braunwald, and for the Clopidogrel as Adjunctive Reperfusion Therapy (CLARITY)–Thrombolysis in Myocardial Infarction (TIMI) 28 Investigators
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