Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study

Mehta, Shamir R.; Yusuf, Salim; Peters, Ron J.G.; Bertrand, Michel E.; Lewis, Basil S.; Natarajan, Madhu K.; Malmberg, Klas; Rupprecht, Hans‐Jürgen; Zhao, Feng; Chrolavicius, Susan; Copland, Ingrid; Fox, Keith

doi:10.1016/s0140-6736(01)05701-4

Cited by 2,821 publications

(935 citation statements)

References 30 publications

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“…33 The PCI-CURE substudy showed also that patients undergoing percutaneous revascularization benefit from dual antiplatelet therapy. 34 Finally, the CREDO trial showed that dual antiplatelet therapy should be continued beyond the usual 30 days because after 1-year treatment, patients in dual therapy experienced a 27% relative risk reduction in death, MI, and stroke compared with patients who were assigned to aspirin alone after the first 30 days of treatment with clopidogrel and aspirin. 35 Kastrati et al showed that patients with low or intermediate risk who had been treated with aspirin and a 600-mg loading dose of clopidogrel before stent implantation do not have additional benefit from abciximab infusion.…”

Section: Thienopyridinesmentioning

confidence: 99%

Aspirin and Clopidogrel

Cattaneo

2004

ATVB

371

133

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Abstract-Aspirin and the thienopyridines ticlopidine and clopidogrel are antiplatelet agents that display good antithrombotic activity. In the past few years, the concept of aspirin resistance has been largely emphasized in the medical literature, although its definition is still uncertain. I suggest that "aspirin-resistant" should be considered as a description for those individuals in whom aspirin fails to inhibit thromboxane A 2 production, irrespective of the results of unspecific tests of platelet function, such as the bleeding time, platelet aggregation, or the PFA-100 system. Less well known than aspirin resistance, but certainly better characterized, is the issue of "clopidogrel resistance," which is probably mostly caused by inefficient metabolism of the prodrug clopidogrel to its active metabolite. At present, aspirin and clopidogrel resistance should not be looked for in the clinical setting, because there is no definite demonstration of an association with clinical events conditioning cost-effective changes in patient management. Key Words: aspirin resistance Ⅲ clopidogrel resistance Ⅲ antiplatelet agents Ⅲ cardiovascular diseases Ⅲ cerebrovascular diseases A spirin and the thienopyridines ticlopidine and clopidogrel are inhibitors of platelet aggregation that display good antithrombotic activity. They are used in the prophylaxis of patients undergoing vascular grafting or percutaneous angioplasty, in the medical management of acute coronary syndromes, and in long-term prevention of cardiovascular and cerebrovascular events.Both aspirin and the thienopyridines selectively inhibit a single pathway of platelet activation: aspirin affects the arachidonate-thromboxane A 2 (TxA 2 ) pathway by irreversibly inhibiting cyclo-oxygenase-1 (COX-1) (Figure 1). 1 The thienopyridines affect the adenosine diphosphate (ADP) pathway, by irreversibly blocking the ADP receptor P2Y 12 ( Figure 1). 2 Despite their selective mechanism of action, which does not counteract the many alternative pathways for platelet activation, aspirin and thienopyridines display a good antithrombotic activity. This is explained by the fact that both the arachidonate-TxA 2 pathway and the ADP pathway contribute to the amplification of platelet activation and are essential for the full aggregation and secretion response of platelets to agonists. 2

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Section: Thienopyridinesmentioning

confidence: 99%

Aspirin and Clopidogrel

Cattaneo

2004

ATVB

371

133

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“…The concept of precatheterization P2Y 12 inhibitor use started after an analysis of the percutaneous coronary intervention (PCI) subset of the CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) trial showed lower major adverse cardiovascular events in patients pretreated with clopidogrel 8. In that study, the median time from presentation to catheterization was 10 days, considerably longer than current practice.…”

Section: Discussionmentioning

confidence: 99%

Precatheterization Use of P2Y ₁₂ Inhibitors in Non‐ST‐Elevation Myocardial Infarction Patients Undergoing Early Cardiac Catheterization and In‐Hospital Coronary Artery Bypass Grafting: Insights From the National Cardiovascular Data Registry ^®

Badri

Abdelbaky

et al. 2017

JAHA

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BackgroundCurrent guidelines recommend early P2Y12 inhibitor administration in non‐ST‐elevation myocardial infarction, but it is unclear if precatheterization use is associated with longer delays to coronary artery bypass grafting (CABG) or higher risk of post‐CABG bleeding and transfusion. This study examines the patterns and outcomes of precatheterization P2Y12 inhibitor use in non‐ST‐elevation myocardial infarction patients who undergo CABG.Methods and ResultsRetrospective analysis was done of 20 304 non‐ST‐elevation myocardial infarction patients in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry (2009–2014) who underwent catheterization within 24 hours of admission and CABG during the index hospitalization. Using inverse probability‐weighted propensity adjustment, we compared time from catheterization to CABG, post‐CABG bleeding, and transfusion rates between patients who did and did not receive precatheterization P2Y12 inhibitors. Among study patients, 32.9% received a precatheterization P2Y12 inhibitor (of these, 2.2% were given ticagrelor and 3.7% prasugrel). Time from catheterization to CABG was longer among patients who received precatheterization P2Y12 inhibitor (median 69.9 hours [25th, 75th percentiles 28.2, 115.8] versus 43.5 hours [21.0, 71.8], P<0.0001), longer for patients treated with prasugrel (median 114.4 hours [66.5, 155.5]) or ticagrelor (90.4 hours [48.7, 124.5]) compared with clopidogrel (69.3 [27.5, 114.6], P<0.0001). Precatheterization P2Y12 inhibitor use was associated with a higher risk of post‐CABG major bleeding (75.7% versus 73.4%, adjusted odds ratio 1.33, 95% confidence interval 1.22‐1.45, P<0.0001) and transfusion (47.6% versus 35.7%, adjusted odds ratio 1.51, 95% confidence interval 1.41‐1.62, P<0001); these relationships did not differ among patients treated with clopidogrel, prasugrel, or ticagrelor.ConclusionsPrecatheterization P2Y12 inhibitor use occurs commonly among non‐ST‐elevation myocardial infarction patients who undergo early catheterization and in‐hospital CABG. Despite longer delays to surgery, the majority of pretreated patients proceed to CABG <3 days postcatheterization. Precatheterization P2Y12 inhibitor use is associated with higher risks of postoperative bleeding and transfusion.

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“…These changes in clinical practice may underlie discordance in results among studies examining outcomes among patients treated with P2Y12 therapy before coronary angiography. Whereas a substudy of the CURE trial showed benefit among patients pretreated with clopidogrel before coronary angiography, the small, randomized ARMYDA‐5 (Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty‐5) PRELOAD and PRAGUE‐8 (PRimary Angioplasty in patients transferred from General community hospitals to specialized PTCA Units with or without Emergency thrombolysis‐8) trials showed no benefit 5, 12, 13. The ACCOAST (Comparison of Prasugrel at the Time of Percutaneous Coronary Intervention or as Pretreatment at the Time of Diagnosis in Patients with Non‐ST Elevation Myocardial Infarction) trial similarly showed no benefit in pretreatment with prasugrel.…”

Section: Introductionmentioning

confidence: 99%

“…The CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) trial showed a 30% reduction in major adverse cardiovascular events when clopidogrel was added to aspirin for treatment of patients presenting with non‐ST‐segment elevation acute coronary syndrome 4. Additionally, within a subset of patients in the CURE trial who were randomized to pretreatment with clopidogrel, results showed the benefits of clopidogrel within 24 hours of randomization and extending long term, without increased bleeding risk 5, 6. Prasugrel, a third‐generation thienopyridine with increased potency compared with clopidogrel, was subsequently developed.…”

Section: Introductionmentioning

confidence: 99%

To Pretreat or Not to Pretreat (With Oral P2Y12 Antagonists)? That is the Question

Lowenstern

Newby

2017

JAHA

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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

Cited by 2,821 publications

References 30 publications

Aspirin and Clopidogrel

Aspirin and Clopidogrel

Precatheterization Use of P2Y ₁₂ Inhibitors in Non‐ST‐Elevation Myocardial Infarction Patients Undergoing Early Cardiac Catheterization and In‐Hospital Coronary Artery Bypass Grafting: Insights From the National Cardiovascular Data Registry ^®

To Pretreat or Not to Pretreat (With Oral P2Y12 Antagonists)? That is the Question

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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

Cited by 2,821 publications

References 30 publications

Aspirin and Clopidogrel

Aspirin and Clopidogrel

Precatheterization Use of P2Y 12 Inhibitors in Non‐ST‐Elevation Myocardial Infarction Patients Undergoing Early Cardiac Catheterization and In‐Hospital Coronary Artery Bypass Grafting: Insights From the National Cardiovascular Data Registry ®

To Pretreat or Not to Pretreat (With Oral P2Y12 Antagonists)? That is the Question

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Precatheterization Use of P2Y ₁₂ Inhibitors in Non‐ST‐Elevation Myocardial Infarction Patients Undergoing Early Cardiac Catheterization and In‐Hospital Coronary Artery Bypass Grafting: Insights From the National Cardiovascular Data Registry ^®