CardioExchange Archive

October 6th, 2010

Study Finds No Evidence for Clopidogrel-Omeprazole Interaction

Sanjay Kaul, MD and Larry Husten, PHD

A large clinical trial has found no evidence that omeprazole interferes with the cardiovascular efficacy of clopidogrel. COGENT (Clopidogrel and the Optimization of Gastrointestinal Events Trial) randomized 3873 patients eligible for dual antiplatelet therapy to receive aspirin, clopidogrel, and either omeprazole or placebo. The COGENT investigators had planned to enroll 5000 patients, but the trial […]

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October 1st, 2010

A Case of Exuberance About a Subgroup in a Clinical Trial

Harlan M. Krumholz, MD, SM

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, […]

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September 20th, 2010

Encouraging Observational Data on Clopidogrel and PPIs

Larry Husten, PHD

Compared with a PPI alone, the combination of clopidogrel and a PPI does not increase risk for cardiovascular events, according to a large observational study from Denmark published in the Annals of Internal Medicine. Mette Charlot and colleagues analyzed data from 56,406 Danish patients discharged after a first MI and found no difference between the […]

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September 19th, 2010

A Rich OASIS for Your Journal Club

Harlan M. Krumholz, MD, SM

I’m always scouting for papers to discuss in journal club with my students. Earlier this month, I found the perfect pair: two simultaneously published articles from the industry-funded CURRENT–OASIS 7 randomized trial, one in the New England Journal of Medicine and the other in the Lancet. Many of the authors of the two papers were […]

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September 1st, 2010

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

Larry Husten, PHD

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 […]

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August 31st, 2010

The CURE for Clopidogrel Genotyping?

Guillaume Pare, MD, MSc

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 […]

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August 29th, 2010

Genetic Substudies of Large Trials Question Value of Clopidogrel Genotyping

Larry Husten, PHD

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 […]

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