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Welcome Ask The Experts March 24-27, 2007 New Orleans, LA

Welcome Ask The Experts March 24-27, 2007 New Orleans, LA. C. Michael Gibson, MS, MD Associate Professor of Medicine Harvard Medical School Chief of Clinical Research Cardiology Division Beth Israel Deaconess Medical Center Boston, MA. Pretreatment with Thienopyridines .

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Welcome Ask The Experts March 24-27, 2007 New Orleans, LA

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  1. Welcome Ask The Experts March 24-27, 2007 New Orleans, LA

  2. C. Michael Gibson, MS, MDAssociate Professor of MedicineHarvard Medical SchoolChief of Clinical ResearchCardiology DivisionBeth Israel Deaconess Medical CenterBoston, MA Pretreatment with Thienopyridines

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

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

  5. 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.

  6. 15 10 5 0 0 6 12 18 24 Cumulative Holter Monitor Ischemia Bival & post PCI Clop (n=101) Pre vs post PCI clop Among bival pts From 4-24 hrs HR = 7.28p = 0.04 Bival & pre PCI Clop (n=112) Cumulative minutes of ischemia(minutes per patient) Epti & post PCI Clop (n=220) Epti & pre PCI Clop(n=217) Hours after end of PCI CM Gibson ACC 2007

  7. 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

  8. 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

  9. 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

  10. 30 Day Outcomes – CABG Patients by Thienopyridine Status • Patients with and without a thienopyridine administered in-hospital prior to CABG

  11. Question & Answer

  12. Thank You! Please make sure to hand in your evaluation and pick up a ClinicalTrialResults.org flash drive

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