Routine clopidogrel before angiography no advantage in subsequent PCI


NEW YORK (Reuters Health), Jul 16 - In patients with stable angina who might be candidates for percutaneous coronary intervention (PCI), there appears to be no benefit to clopidogrel pretreatment before they undergo elective angiography. In fact, it may increase minor bleeding complications, according to Czech researchers.

The study, lead investigator Dr. Petr Widimsky told Reuters Health, "proved that patients with chronic stable angina undergoing planned elective coronary angiography do not need to be pretreated by clopidogrel. Rather, they should receive clopidogrel based on the angiography result."

As reported in the June issue of the European Heart Journal, Widimsky of Charles University, Prague, and colleagues conducted an open-label trial involving 1,028 patients with stable angina. They were randomized to receive 600 mg of clopidogrel within six hours before angiography or only immediately prior to subsequent PCI if they required the procedure.

After adjustment, the team found that the pre-angiography group was significantly more likely than the pre-PCI group to suffer minor bleeding complications (odds ratio = 3.03).

In addition, there was no between-group difference in rates of a composite end point of death, periprocedural myocardial infarction, stroke, or reintervention within seven days.

In an accompanying editorial, Dr. Jean-Pierre Bassand and colleagues at University Hospital Jean Minjoz, Besancon, France, call the findings interesting, but express a number of reservations.

In particular, they note that newer agents that inhibit platelet aggregation by more than 70% within half an hour may render pretreatment unnecessary.

Eur Heart J 2008;29:1475-1477,1495-1503.

Last Updated: 2008-07-15 16:19:56 -0400 (Reuters Health)

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