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Emerging Data Regarding the Potential Benefits of Early Initiation of Clopidogrel Among ACS Patients

Emerging Data Regarding the Potential Benefits of Early Initiation of Clopidogrel Among ACS Patients. C. Michael Gibson, M.S., M.D. Inhibition of Platelet Aggregation Following Clopidogrel Administration. Hochholzer W et al. Circulation. 2005;111. Clopidogrel.

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Emerging Data Regarding the Potential Benefits of Early Initiation of Clopidogrel Among ACS Patients

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  1. Emerging Data Regarding the Potential Benefits of Early Initiation of Clopidogrel Among ACS Patients C. Michael Gibson, M.S., M.D.

  2. Inhibition of Platelet Aggregation Following Clopidogrel Administration Hochholzer W et al. Circulation. 2005;111

  3. Clopidogrel Clopidogrel Loading Dose Timing and Risk of MACE Log Odds of Death, MI or UTVR at 28 Days Placebo - 2 P = 0.020 for treatment / timing interaction - 3 - 4 - 5 - 6 0 5 10 15 20 25 30 Hours Prior to PCI of Study Drug Loading Dose J Am Coll Cardiol 2006;47:939–43.

  4. Influence of Thienopyridine Exposure – PCI pts 30 Day Primary Endpoint Adverse Events RR [95%CI] 0.81 (0.68-0.96) RR [95%CI] 0.96 (0.77-1.20) RR [95%CI] 0.50 (0.37-0.67) RR [95%CI] 1.07 (0.83-1.39) RR [95%CI] 1.37 (1.00-1.88) RR [95%CI] 0.61 (0.39-0.97) Thienopyridine Exposed Not Thienopyridine Exposed

  5. Clopidogrel stopped <5 days prior to CABG Clopidogrel stopped >5 days prior to CABG CURE: Major Bleeding in CABG Patients • Major or life-threatening bleeding w/in 7 days of CABG P=0.07 P=0.53 K.Fox et al, ESC 2002

  6. ACUITY: Primary Outcomes in CABG Patients • Patients with and without a thienopyridine administered in-hospital prior to CABG P=0.066 P=0.013 P=0.362 *Heparin=unfractionated or enoxaparin

  7. 30 Day Outcomes – CABG Patients by Thienopyridine Status • Patients with and without a thienopyridine administered in-hospital prior to CABG

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