Outcome Comparison of 600 mg versus 300 mg Loading dose of Clopidogrel for Patients with ST-Elevation Myocardial Infarction: A Meta-Analysis

Vyas, Ankur; Accaoui, Ramzi El; Blevins, Amy; Karrowni, Wassef

doi:10.3810/pgm.2014.09.2812

Cited by 7 publications

(3 citation statements)

References 33 publications

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“…This is most likely caused by pharmacological interventions of the patients. In accordance, it has previously been shown that pre-hospital medication with 300 mg aspirin caused a 50% reduction in platelet aggregation using AA stimulation whereas anti-platelet effect of clopidogrel was observed after 72 h [28]. The rapid effect of aspirin is expected based on the known pharmacokinetics of aspirin and the ISIS-2 study published three decades ago that showed a beneficial effect of platelet inhibition [29,30].…”

Section: Discussionmentioning

confidence: 59%

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Increased plasma cathepsin S and trombospondin-1 in patients with acute ST-segment elevation myocardial infarction

et al. 2019

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Section: Discussionmentioning

confidence: 59%

“…This may explain the modest effect on platelets stimulated by ADP. In comparison, other studies have shown that a higher loading dose (600 mg) induces a more rapid and significantly better effect of the drug [28]. The time from medication with clopidogrel to the arrival at the catherization laboratory was approximately 80 min.…”

Section: Discussionmentioning

confidence: 78%

Increased plasma cathepsin S and trombospondin-1 in patients with acute ST-segment elevation myocardial infarction

et al. 2019

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“…Several recent cardiology trials suggest that a loading dose of 600 mg might be more effective in preventing major adverse cardiac events, without increasing the risk of bleeding. 15 However, for PAOD patients there is no evidence that suggests superiority of a higher loading dose.…”

Section: Post-procedural Antiplatelet Therapymentioning

confidence: 99%

Personalized Antiplatelet Therapy Following Endovascular Revascularization in Peripheral Artery Occlusive Disease: A Novel Concept

Weem

Leunissen

Teraa

et al. 2015

EJVES Short Reports

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Case:A 73 year old patient with a longstanding history of peripheral artery occlusive disease (PAOD) presented with an acute on chronic progression of symptoms, based on a long occlusion of the superficial femoral artery (SFA), which was treated by thrombosuction, percutaneous transluminal angioplasty, and SFA stenting. Postprocedural dual antiplatelet therapy was initiated and subsequently adjusted based on platelet reactivity testing. Discussion: Increasingly complex arterial lesions are treated by an endovascular approach; however, long-term patency rates are often disappointing. In order to optimize the patency rates (dual) antiplatelet therapy is initiated. It is known that a substantial proportion of patients have high platelet reactivity despite the use of antiplatelet drugs. Several methods have been published to test the individual response to different antiplatelet drugs. There is evidence that adjusting antiplatelet therapy based on platelet reactivity testing results in a reduction of cardiovascular events and bleeding complications; however, the optimal test and the exact role of personalized antiplatelet therapy in PAOD is currently unknown.

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Treatment Effects in Randomized and Nonrandomized Studies of Pharmacological Interventions

Salcher-Konrad,

Nguyen,

Savović

et al. 2024

JAMA Netw Open

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ImportanceRandomized clinical trials (RCTs) are widely regarded as the methodological benchmark for assessing clinical efficacy and safety of health interventions. There is growing interest in using nonrandomized studies to assess efficacy and safety of new drugs.ObjectiveTo determine how treatment effects for the same drug compare when evaluated in nonrandomized vs randomized studies.Data SourcesMeta-analyses published between 2009 and 2018 were identified in MEDLINE via PubMed and the Cochrane Database of Systematic Reviews. Data analysis was conducted from October 2019 to July 2024.Study SelectionMeta-analyses of pharmacological interventions were eligible for inclusion if both randomized and nonrandomized studies contributed to a single meta-analytic estimate.Data Extraction and SynthesisFor this meta-analysis using a meta-epidemiological framework, separate summary effect size estimates were calculated for nonrandomized and randomized studies within each meta-analysis using a random-effects model and then these estimates were compared. The reporting of this study followed the Guidelines for Reporting Meta-Epidemiological Methodology Research and relevant portions of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline.Main Outcome and MeasuresThe primary outcome was discrepancies in treatment effects obtained from nonrandomized and randomized studies, as measured by the proportion of meta-analyses where the 2 study types disagreed about the direction or magnitude of effect, disagreed beyond chance about the effect size estimate, and the summary ratio of odds ratios (ROR) obtained from nonrandomized vs randomized studies combined across all meta-analyses.ResultsA total of 346 meta-analyses with 2746 studies were included. Statistical conclusions about drug benefits and harms were different for 130 of 346 meta-analyses (37.6%) when focusing solely on either nonrandomized or randomized studies. Disagreements were beyond chance for 54 meta-analyses (15.6%). Across all meta-analyses, there was no strong evidence of consistent differences in treatment effects obtained from nonrandomized vs randomized studies (summary ROR, 0.95; 95% credible interval [CrI], 0.89-1.02). Compared with experimental nonrandomized studies, randomized studies produced on average a 19% smaller treatment effect (ROR, 0.81; 95% CrI, 0.68-0.97). There was increased heterogeneity in effect size estimates obtained from nonrandomized compared with randomized studies.Conclusions and RelevanceIn this meta-analysis of treatment effects of pharmacological interventions obtained from randomized and nonrandomized studies, there was no overall difference in effect size estimates between study types on average, but nonrandomized studies both overestimated and underestimated treatment effects observed in randomized studies and introduced additional uncertainty. These findings suggest that relying on nonrandomized studies as substitutes for RCTs may introduce additional uncertainty about the therapeutic effects of new drugs.

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Outcome Comparison of 600 mg versus 300 mg Loading dose of Clopidogrel for Patients with ST-Elevation Myocardial Infarction: A Meta-Analysis

Abstract: In ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention, administration of a 600-mg LD of clopidogrel is associated with a lower risk of MACE than is administration of a 300-mg LD, without increasing the risk of major bleeding.

Cited by 7 publications

References 33 publications

Increased plasma cathepsin S and trombospondin-1 in patients with acute ST-segment elevation myocardial infarction

Increased plasma cathepsin S and trombospondin-1 in patients with acute ST-segment elevation myocardial infarction

Personalized Antiplatelet Therapy Following Endovascular Revascularization in Peripheral Artery Occlusive Disease: A Novel Concept

Treatment Effects in Randomized and Nonrandomized Studies of Pharmacological Interventions

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