Posts Tagged ‘ACS’

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November 8th, 2010

Up-Front Clopidogrel Loading Versus Common Sense

From time to time, a sales representative visits my office promoting clopidogrel (Plavix) as a drug that patients who present with unstable angina/non–ST-segment-elevation MI (UA/NSTEMI) should start immediately as an up-front load. That strategy hasn’t been uniformly accepted in my clinician community because of concern about using an irreversible antiplatelet agent to treat patients who […]


November 4th, 2010

Clopidogrel and CYP2C19: What’s All the Fuss About?

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You’ve heard a lot lately about so-called “clopidogrel resistance.” That sounds straightforward, but the underlying reason can be complex, possibly related to how the drug is metabolized by subjects with a certain genetic profile. We seek here to provide some perspective about clopidogrel’s metabolic and gene-related complexities. First, some brief background: Clopidogrel, a thienopyridine, is a […]


November 3rd, 2010

Do Your Patients Wait to Fill Their Plavix and Effient Prescriptions After Drug-Eluting Stent Implantation?

I recently read an article in the journal Circulation that contained an alarming finding about patients who receive drug-eluting stents. Apparently, 1 in 6 did not fill their clopidogrel prescriptions immediately after discharge from a hospital in one of three large integrated health care systems. The median delay was 3 days. Furthermore, during a median follow-up […]


October 1st, 2010

A Case of Exuberance About a Subgroup in a Clinical Trial

In many clinical trials, researchers investigate whether an overall effect of an intervention is consistent across various subgroups, as I discussed in this Journal Club Series last week. Such subgroup analyses require assessment of what is called an interaction — that is, whether the effect in one group differs from that in another. Do the benefits differ, […]


September 1st, 2010

Clopidogrel and Aspirin Dosages Scrutinized in CURRENT-OASIS 7 Papers and Editorials

In the CURRENT-OASIS 7 trial, more than 25,000 patients with ACS for whom an interventional strategy was planned were randomized to either double-dose clopdiogrel (a 600-mg loading dose on the first day followed by 150 mg daily for 6 days and 75 mg daily thereafter) or standard-dose clopidogrel (a 300-mg loading dose, followed by 75 mg […]


August 31st, 2010

The CURE for Clopidogrel Genotyping?

CardioExchange welcomes Guillaume Paré to discuss his team’s work on the  utility of clopidogrel genotyping. The researchers genotyped for CYP2C19 alleles associated with loss-of-function or gain-of-function of clopidogrel in some 5,000 patients with ACS or A-fib from two large randomized trials. In both studies, clopidogrel had similar efficacy over placebo regardless of whether patients had […]


August 29th, 2010

Genetic Substudies of Large Trials Question Value of Clopidogrel Genotyping

Genetic substudies across a broad range of large clinical trials that used clopidogrel raise questions about the clinical utility of clopidogrel genotyping. The substudies come from large and important trials like PLATO, TRITON-TIMI 38, CURE, and ACTIVE A. A genetic substudy of PLATO finds that ticagrelor is superior to clopidogrel irrespective of genetic subtype. Therefore, according […]


August 9th, 2010

The GP IIb/IIIa Inhibitor Wars: Not Ready To Surrender

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Although two recent studies (EVA-MI and SCAAR) report that eptifibatide is as effective as abciximab with respect to myocardial reperfusion and clinical events in patients undergoing primary PCI, the thoughtful and balanced editorial accompanying them points out that the studies “ought not be considered convincing or as level 1 evidence” that the GP IIb/IIIa inhibitors […]


August 5th, 2010

Three Questions about Ticagrelor: Part 3 — Jonathan Halperin

PLATO is one of the most impressive trials in recent years, demonstrating substantial benefits for ticagrelor over clopidogrel in a wide population of ACS patients. However, patients enrolled in the US showed no benefit from ticagrelor, and experts have been unable to agree on a cause. Possible factors could include much higher doses of aspirin used in the […]


August 4th, 2010

Three Questions about Ticagrelor: Part 2 — Mori Krantz

PLATO is one of the most impressive trials in recent years, demonstrating substantial benefits for ticagrelor over clopidogrel in a wide population of ACS patients. However, patients enrolled in the US were found to have no benefit from ticagrelor, and experts have been unable to agree on a cause. Possible factors could include much higher doses […]