American Heart Journal
Volume 157, Issue 1 , Pages 60.e1-60.e9 , January 2009

Randomized trial comparing 600- with 300-mg loading dose of clopidogrel in patients with non–ST elevation acute coronary syndrome undergoing percutaneous coronary intervention: Results of the Platelet Responsiveness to Aspirin and Clopidogrel and Troponin Increment after Coronary intervention in Acute coronary Lesions (PRACTICAL) Trial

  • Gerald Yong, MBBS(Hons)

      Affiliations

    • Royal Perth Hospital, Perth, Western Australia, Australia
    • ,
  • Jamie Rankin, MBBS

      Affiliations

    • Royal Perth Hospital, Perth, Western Australia, Australia
    • Corresponding Author InformationReprint requests: Jamie Rankin, MBBS, Royal Perth Hospital, Perth, WA, Australia.
    • ,
  • Louise Ferguson, BAppSc

      Affiliations

    • Royal Perth Hospital, Perth, Western Australia, Australia
    • ,
  • Jim Thom, MSc

      Affiliations

    • Royal Perth Hospital, Perth, Western Australia, Australia
    • ,
  • John French, MBChB, PhD

      Affiliations

    • Liverpool Hospital, Sydney, New South Wales, Australia
    • ,
  • David Brieger, MBBS, PhD

      Affiliations

    • Concord Hospital, Concord, New South Wales, Australia
    • ,
  • Derek P. Chew, MBBS, MPH

      Affiliations

    • Flinders University, Bedford Park, South Australia, Australia
    • ,
  • Ron Dick, MBBS

      Affiliations

    • Epworth Hospital, Richmond, Victoria, Australia
    • ,
  • David Eccleston, MBBS, MMedSci

      Affiliations

    • Royal Melbourne Hospital, Parkville, Victoria, Australia
    • ,
  • Bernard Hockings, MD, BS

      Affiliations

    • University of Western Australia, Nedlands, Western Australia, Australia
    • ,
  • Darren Walters, MBBS, Mphil

      Affiliations

    • Prince Charles Hospital, Chermside, Queensland, Australia
    • ,
  • Alan Whelan, MBBS, BSc

      Affiliations

    • Fremantle Hospital, Fremantle, Western Australia, Australia
    • ,
  • John W. Eikelboom, MBBS

      Affiliations

    • Department of Medicine, McMaster University, Hamilton, Ontario, Canada

Received 6 June 2008 ,Accepted 29 September 2008.

References 

  1. Kizer JR, Muttrej MR, Matthai WH, et al. Role of cardiac troponin T in the long-term risk stratification of patients undergoing percutaneous coronary intervention. Eur Heart J. 2003;24:1314–1322
  2. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005;293:2126–2130
  3. Cuisset T, Frere C, Quilici J, et al. High post-treatment platelet reactivity identified low-responders to dual antiplatelet therapy at increased risk of recurrent cardiovascular events after stenting for acute coronary syndrome. J Thromb Haemost. 2006;4:542–549
  4. Gurbel PA, Bliden KP, Zaman KA, et al. Clopidogrel loading with eptifibatide to arrest the reactivity of platelets: results of the Clopidogrel Loading With Eptifibatide to Arrest the Reactivity of Platelets (CLEAR PLATELETS) study. Circulation. 2005;111:1153–1159
  5. Gurbel PA, Bliden KP, Guyer K, et al. Platelet reactivity in patients and recurrent events post-stenting: results of the PREPARE POST-STENTING Study. J Am Coll Cardiol. 2005;46:1820–1826
  6. von Beckerath N, Taubert D, Pogatsa-Murray G, et al. Absorption, metabolization, and antiplatelet effects of 300-, 600-, and 900-mg loading doses of clopidogrel: results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) Trial. Circulation. 2005;112:2946–2950
  7. Montalescot G, Sideris G, Meuleman C, et al. A randomized comparison of high clopidogrel loading doses in patients with non–ST-segment elevation acute coronary syndromes: the ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) trial. J Am Coll Cardiol. 2006;48:931–938
  8. Muller I, Seyfarth M, Rudiger S, et al. Effect of a high loading dose of clopidogrel on platelet function in patients undergoing coronary stent placement. Heart. 2001;85:92–93
  9. Gurbel PA, Bliden KP, Hiatt BL, et al. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation. 2003;107:2908–2913
  10. Patti G, Colonna G, Pasceri V, et al. Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: results from the ARMYDA-2 (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) study. Circulation. 2005;111:2099–2106
  11. Kastrati A, Mehilli J, Neumann FJ, et al. Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial. JAMA. 2006;295:1531–1538
  12. Cannon CP, Battler A, Brindis RG, et al. American College of Cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes. A report of the American College of Cardiology Task Force on Clinical Data Standards (Acute Coronary Syndromes Writing Committee). J Am Coll Cardiol. 2001;38:2114–2130
  13. Cuisset T, Frere C, Quilici J, et al. Benefit of a 600-mg loading dose of clopidogrel on platelet reactivity and clinical outcomes in patients with non–ST-segment elevation acute coronary syndrome undergoing coronary stenting. J Am Coll Cardiol. 2006;48:1339–1345
  14. Silber S, Albertsson P, Aviles FF, et al. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J. 2005;26:804–847
  15. Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, et al. High clopidogrel loading dose during coronary stenting: effects on drug response and interindividual variability. Eur Heart J. 2004;25:1903–1910
  16. Jernberg T, Payne CD, Winters KJ, et al. Prasugrel achieves greater inhibition of platelet aggregation and a lower rate of non-responders compared with clopidogrel in aspirin-treated patients with stable coronary artery disease. Eur Heart J. 2006;27:1166–1173
  17. Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357:2001–2015

 Clinical Trial Registration Information: Australian Clinical Trials Registry (http://www.actr.org.au/) number ACTRN012605000581662.

 This study was supported by an unrestricted educational grant from Sanofi-Aventis, Sydney, Australia.

PII: S0002-8703(08)00831-4

doi: 10.1016/j.ahj.2008.09.024

American Heart Journal
Volume 157, Issue 1 , Pages 60.e1-60.e9 , January 2009

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