Clopidogrel, Ticlopidine, Aspirin 1991-2001
TCTMD Expert Presentations
TCT 2001 Abstracts
Meta-analysis of randomized and registry
comparisons of ticlopidine with clopidogrel after stenting
Bhatt DL, et al.
J Am Coll Cardiol 2002;39:9-14
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11755280
Based on all available evidence from randomized clinical trials or
registries, clopidogrel, in addition to better tolerability and fewer side
effects, is at least as efficacious as ticlopidine in reducing MACE. This
finding may be due to the more rapid onset of an antiplatelet effect seen with
the loading dose of clopidogrel, which was used in most of these studies, or to
better patient compliance with clopidogrel therapy. Therefore, clopidogrel
plus aspirin should replace ticlopidine plus aspirin as the standard
antiplatelet regimen after stent deployment
ADJUNCTIVE THERAPY WITH ANTIPLATELET AGENTS
PREVENTS STENT THROMBOSIS
Current recommendations include
adjunctive treatment with aspirin and the ADP receptor inhibitors ticlopidine or
clopidogrel.
Drug & Ther Perspect 17(4):8-11, 2001
http://cardiology.medscape.com/35598.rhtml?srcmp=card-033001
Combination therapy with aspirin plus
clopidogrel versus aspirin plus ticlopidine for prevention of subacute
thrombosis after successful native coronary stenting
Dangas G, et al.
Am J Cardiol 2001;87:470-2, A7
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11179539
The Authors compared the combination of aspirin plus clopidrogrel (A+C) with
aspirin and ticlopidine (A+T) for prevention of subacute stent thrombosis in 827
patients. At 30-day follow-up, there were trends toward increased subacute
thrombosis with A+C compared with A+T (1.3% vs 0.2%, p = 0.10). These results
suggest that A+C may have marginally higher subacute stent thrombosis than A+T.
Randomized comparison of ticlopidine and
clopidogrel after intracoronary stent implantation in a broad patient population
Taniuchi M, et al.
Circulation 2001;104:539-43
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11479250
Clopidogrel is better tolerated than ticlopidine during a 2-week regimen after
intracoronary stent implantation. Combining either thienopyridine with an
intravenous platelet IIb/IIIa inhibitor appears to be safe. When applied to a
broad spectrum of patients receiving stent implantation, clopidogrel confers
similar protection as ticlopidine against subacute stent thrombosis and major
adverse cardiac events.
Meta-analysis of randomized and registry
comparisons of ticlopidine with clopidogrel after stenting
D.L. Bhatt, M.E. Bertrand, P.B. Berger, P.L. L'Allier, I. Moussa, J.W. Moses,
G. Dangas, M. Taniuchi, J.M. Lasala, D.R. Holmes, S.G. Ellis, E.J. Topol
J Am Coll Cardiol 2002;39:9-14
CURE - Effects of clopidogrel in addition to
aspirin in patients with acute coronary syndromes without ST-segment elevation
Yusuf S, et al.
N Engl J Med 2001;345:494-502
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11519503
The antiplatelet agent clopidogrel has beneficial effects in patients with acute
coronary syndromes without ST-segment elevation. However, the risk of major
bleeding is increased among patients treated with clopidogrel.
Synopsis: http://www.tctmd.com/journal-synopses/one.html?synopsis_id=2281
Clopidogrel Reduces Risk of MI, Stroke
and Cardiovascular Death in CURE
presented by Salim Yusuf, MD
http://www.tctmd.com/ct/enewsletter-20010322/$user_id/?send_to=http://www.tctmd.com/meeting-news/one.html?news_item_id=2002
Ticlopidine versus aspirin after myocardial
infarction (STAMI) trial
Scrutinio D, et al.
J Am Coll Cardiol 2001;37:1259-65
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11300432
No difference was found between the ticlopidine and aspirin groups in the rate
of the primary combined end point of death, recurrent AMI, stroke and angina.
Incidence of thrombotic occlusion and
major adverse cardiac events between two and four weeks after coronary stent
placement: analysis of 5,678 patients with a four-week ticlopidine regimen
Schuhlen H, et al.
J Am Coll Cardiol 2001;37:2066-73
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11419889
RISK FACTORS SHOULD DETERMINE LENGTH OF
TICLOPIDINE THERAPY AFTER STENTING
Whether patients receive only 2 weeks
of ticlopidine therapy after coronary stent implantation should be based on an
analysis of patient risk factors, not only on the desire to minimize the risk of
hematologic complications, German researchers advise.
http://cardiology.medscape.com/39116.rhtml?srcmp=card-061501
INHIBITION BY COMBINED THERAPY WITH
TICLOPIDINE AND ASPIRIN OF ENHANCED PLATELET AGGREGATION DURING PHYSICAL
EXERCISE IN PATIENTS WITH CORONARY ARTERY DISEASE
Current investigations revealed that the rupture of atheroma and subsequent
formation of occlusive thrombus in the coronary artery are crucial events
leading to the onset of acute myocardial infarction.
Am Heart J 142(2):262, 2001
http://cardiology.medscape.com/43409.rhtml?srcmp=card-100501
Comparison of effects of clopidogrel versus
ticlopidine on platelet function in patients undergoing coronary stent placement
Gawaz M, et al.
Am J Cardiol 2001;87:332-6, A9
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11165971
Clopidogrel in combination with aspirin administered as a loading dose of 450 mg
reveals an accelerated antiplatelet effect in the early hours after first
administration in patients undergoing coronary stent placement.
Comparison of ticlopidine and
cilostazol for the prevention of restenosis after percutaneous transluminal
coronary angioplasty
Nagaoka N, et al.
Jpn Heart J 2001;42:43-54
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11324805
Cilostazol for prevention of thrombosis and
restenosis after intracoronary stenting
El-Beyrouty C, et al.
Ann Pharmacother 2001;35:1108-13
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11573862
In seven randomized trials comparing cilostazol with either aspirin or
ticlopidine, cilostazol was found to be superior to aspirin and equivalent to
ticlopidine in decreasing both cardiac events and rates of restenosis. In
addition, cilostazol was found to be well tolerated, with no reports of adverse
hematologic events
Scientific letter
Effect of a high loading dose of clopidogrel on platelet function in patients
undergoing coronary stent placement
Muller I et al.
Heart 2001;85 92-93
http://www.heartjnl.com/cgi/content/full/85/1/92
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ESC 2001 Meeting Coverage
PCI-CURE: The Value of PCI
Pretreatment With Antiplatelets
Comment
- 1 Comment
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Effects of pretreatment with
clopidogrel and aspirin followed by long-term therapy in patients undergoing
percutaneous coronary intervention: the PCI-CURE study
Mehta SR, et al.
Lancet 2001;358:527-33
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11520521
Sustained benefit over four
years from an initial combined antiplatelet regimen after coronary stent
placement in the ISAR trial. Intracoronary Stenting and Antithrombotic Regimen
Schuhlen H, et al.
Am J Cardiol 2001;87:397-400
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11179521
ACC Current Journal Review Sep/Oct 2001
Ticlopidine pretreatment before coronary stenting is associated with sustsained
decrease of adverse cardiac events: data from the evaluation of platelet IIb/IIIa
inhibitor for stenting (EPISTENT trial)
R. Steinhubl, S.G. Ellis, K.
Wolski K
pages 60
Abstract
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Profile and prevalence of aspirin resistance
in patients with cardiovascular disease
Gum PA, et al.
Am J Cardiol 2001;88:230-5
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11472699
By optical aggregation, 5.5% of the patients were aspirin resistant and 23.8%
were aspirin semiresponders. By PFA-100, 9.5% of patients were aspirin resistant.
Of the 18 patients who were aspirin resistant by aggregation, 4 were also
aspirin resistant by PFA-100.
Thrombotic thrombocytopenic purpura associated with Clopidogrel
Bennet CL et al.
N Engl J Med 2000
http://www.cardio.unina.it/elettro/ptt.htm
TCT 2000 Meeting Coverage
CLASSICS - Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting : the clopidogrel aspirin stent international cooperative study
Bertrand ME et al.
Circulation 2000;102:624-9
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010931801
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The safety/tolerability of clopidogrel (plus aspirin) is superior to that of ticlopidine (plus
aspirin) (P=0.005). The 300-mg loading dose was well tolerated, notably with no increased risk of
bleeding. Secondary end point data are consistent with the hypothesis that clopidogrel and ticlopidine have comparable efficacy with regard to cardiac events after successful
stenting.
Clinical outcome at six months of coronary
stenting followed by ticlopidine monotherapy
Elsner M, et al.
Am J Cardiol 1998;81:147-51.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9591896
Ticlopidine and aspirin interactions
Gregorini L, et al.
Heart 1997;77:11-2.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9038687
Ticlopidine and aspirin pretreatment reduces
coagulation and platelet activation during coronary dilation procedures
Gregorini L, et al.
J Am Coll Cardiol 1997;29:13-20.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=8996289
Results of a consecutive series of patients
receiving only antiplatelet therapy after optimized stent implantation.
Comparison of aspirin alone versus combined ticlopidine and aspirin therapy
Albiero R, et al.
Circulation 1997;95:1145-56.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9054843
Combined antiplatelet therapy with
ticlopidine and aspirin. A simplified approach to intracoronary stent management
Lablanche JM, et al.
Eur Heart J 1996;17:1373-80.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=8880023
Comparison of aspirin alone versus aspirin
plus ticlopidine after coronary artery stenting
Goods CM, et al.
Am J Cardiol 1996;78:1042-4.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=8916486
Two-pronged antiplatelet therapy with
aspirin and ticlopidine without systemic anticoagulation: an alternative
therapeutic strategy after bailout stent implantation
Van Belle E, et al.
Coron Artery Dis 1995;6:341-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=7655719
Randomized trial of ridogrel, a combined
thromboxane A2 synthase inhibitor and thromboxane A2/prostaglandin endoperoxide
receptor antagonist, versus aspirin as adjunct to thrombolysis in patients with
acute myocardial infarction. The Ridogrel Versus Aspirin Patency Trial (RAPT)
Circulation 1994;89:588-95.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=8313547
Combined administration of aspirin and a
specific thrombin inhibitor in man
Clarke RJ, et al.
Circulation 1991;83:1510-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=2022012