Clopidogrel suggested as standard treatment after stenting

NEW YORK (Reuters Health) – Clopidogrel is just as effective as ticlopidine in reducing major adverse cardiac events after coronary stenting, and it is better tolerated with fewer side effects, according to a report in the January 2nd issue of the Journal of the American College of Cardiology.

Previous studies have shown that clopidogrel is safer and better tolerated than ticlopidine. However, it was unclear whether clopidogrel was as effective as ticlopidine in reducing ischemic end points because the studies were not powered to detect a difference.

To overcome this problem, Dr. Eric J. Topol, from the Cleveland Clinic Foundation, and colleagues performed a meta-analysis of three randomized trials and seven single-center registries in which participants received clopidogrel or ticlopidine after coronary stent placement. The studies included a total of 13,955 patients.

The pooled rates of major adverse cardiac events in the clopidogrel and ticlopidine groups were 2.10% and 4.04%, respectively (p = 0.001). "After adjustment for heterogeneity in the trials, the odds ratio of having an ischemic event with clopidogrel as compared with ticlopidine was 0.72," the investigators report. In addition, the mortality rate in the ticlopidine group was 1.09%, while the rate in the clopidogrel group was only 0.48% (p = 0.003).

"The beneficial effect of clopidogrel observed in this analysis may be due to the more rapid onset of an antiplatelet effect seen with the loading dose of clopidogrel used in most of these studies, or to better patient compliance with clopidogrel therapy," the authors note.

"Unless new, large and definitive randomized clinical trials are performed, clopidogrel plus aspirin should be regarded as the standard of care for patients who have received coronary stents," Dr. Topol's team concludes.

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