Document Detail


Clopidogrel in addition to aspirin reduces in-hospital major cardiac and cerebrovascular events in unselected patients with acute ST segment elevation myocardial.
MedLine Citation:
PMID:  18217148     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We sought to assess the effect of clopidogrel on in-hospital events in unselected patients with acute ST elevation myocardial infarction (STEMI). In a retrospective analysis of consecutive patients enrolled in the Acute Coronary Syndromes (ACOS) registry with acute STEMI we compared outcomes of either adjunctive therapy with aspirin alone or aspirin plus clopidogrel within 24 hours after admission.A total of 7,559 patients were included in this analysis, of whom 3,541 were treated with aspirin alone, and 4,018 with dual antiplatelet therapy. The multivariable analysis with adjustment for baseline characteristics and treatments showed that the rate of in-hospital MACCE (death, non-fatal reinfarction, non-fatal stroke) was significantly lower in the aspirin plus clopidogrel group,compared to the aspirin alone group in the entire cohort and all three reperfusion strategy groups (entire group odds ratio 0.60, 95% CI 0.49-0.72 , no reperfusion OR 0.69,95% CI 0.51-0.94,fibrinolysis OR 0.62,95% CI 0.44-0.88, primary PCI OR 0.54, 95% CI 0.39-0.74). There was a significant increase in major bleeding complications with clopidogrel (7.1% vs. 3.4%, p<0.001). In clinical practice early adjunctive therapy with clopidogrel in addition to aspirin in patients with STEMI is associated with a significant reduction of in-hospital MACCE regardless of the initial reperfusion strategy. This advantage was associated with an increase in major bleeding complications.
Authors:
Uwe Zeymer; Anselm Gitt; Claus Jünger; Timm Bauer; Tobias Heer; Oliver Koeth; B Mark; Ralf Zahn; Jochen Senges; M Gottwik
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Thrombosis and haemostasis     Volume:  99     ISSN:  0340-6245     ISO Abbreviation:  Thromb. Haemost.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-24     Completed Date:  2008-02-21     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  7608063     Medline TA:  Thromb Haemost     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  155-60     Citation Subset:  IM    
Affiliation:
Herzzentrum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany. Uwe.Zeymer@t-online.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects
Aspirin / adverse effects,  therapeutic use*
Cerebrovascular Disorders / etiology,  mortality,  prevention & control*
Drug Therapy, Combination
Female
Heart Diseases / etiology,  mortality,  prevention & control*
Hemorrhage / chemically induced
Hospital Mortality
Hospitalization
Humans
Male
Middle Aged
Myocardial Infarction / complications,  drug therapy*,  mortality,  therapy
Odds Ratio
Platelet Aggregation Inhibitors / adverse effects,  therapeutic use*
Recurrence / prevention & control
Research Design
Retrospective Studies
Risk Assessment
Risk Factors
Stroke / prevention & control
Thrombolytic Therapy* / adverse effects
Ticlopidine / adverse effects,  analogs & derivatives*,  therapeutic use
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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