Role of clopidogrel in addition to aspirin in the prevention of recurrent ischaemic events in acute coronary syndrome with ST-segment elevation

Authors

  • Vasavi Patra Department of Pharmacology, Spark Hospitals, Peerzadiguda, Uppal, Hyderabad, Telangana, India
  • Victor Emmanuel Ulchala Department of General Medicine, Spark Hospitals, Peerzadiguda, Uppal, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20183002

Keywords:

Acute coronary syndrome, Aspirin, Clopidogrel, ST-segment elevation myocardial infarction

Abstract

Background: Studies regarding the efficacy of Aspirin alone versus combination of Aspirin and Clopidogrel in patients with Unstable Angina are many. But, studies on the comparative role of Aspirin alone versus Aspirin plus Clopidogrel in the background of Acute Coronary Syndrome (ACS) with ST segment elevation myocardial infarction (STEMI) were very few, at the time of starting of this study. Keeping this in mind present study was conducted to compare the efficacy and safety of Aspirin alone with combination of aspirin plus Clopidogrel in prevention of events in Acute Coronary Syndrome with ST segment elevation myocardial infarction.

Methods: Patients who are admitted to intensive coronary care unit within 12hrs after the onset of symptoms and whose diagnosis as ACS with ST segment elevation has been established were included in this study. Patients in group 1 received 325 mg of aspirin as loading dose, followed by 150 mg once daily. Patients in group 2 received a combination of aspirin and Clopidogrel 325 and 300 mg, respectively, as loading dose, followed by 150 mg of aspirin and 75 mg of Clopidogrel daily. All the patients received a fibrinolytic agent. Treatment response was weighed against the primary and secondary expected outcomes.

Results: Addition of Clopidogrel to Aspirin resulted in significant reduction in severe ischaemia not requiring urgent revascularisation i.e.; 32% in Aspirin alone group versus 10% in Aspirin plus Clopidogrel group and recurrent angina with no ECG changes i.e.; 42% in aspirin alone group versus 20% in Aspirin plus Clopidogrel group. Similarly, there was an improvement in ejection fraction at the end of one month i.e.; 0.3% in Aspirin alone group versus 1.85% in Aspirin plus Clopidogrel group.

Conclusions: This study demonstrates the benefit of adding Clopidogrel to Aspirin for myocardial infarction with ST-segment elevation. Treatment with a loading dose of 300mg of Clopidogrel followed by a daily dose of 75mg, in addition to aspirin, resulted in significant improvement in the secondary efficacy related outcomes in patients with acute coronary syndrome with ST-segment elevation.

References

Myocardial infarction redefined-a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol. 2000;36:959.

Patrono C. Aspirin as an antiplatelet drug. N Engl J Med. 1994;330:1287.

Maalej N, Folts JD. Increased shear stress overcomes the antithrombotic platelet inhibitory effect of aspirin in stenosed dog coronary arteries. Circulation. 1996;93:1201.

Foster CJ, Prosser DM, Agans JM, Zhai Y, Smith MD, Lachowicz JE, et al. Molecular identification and characterization of the platelet ADP receptor targeted by thienopyridine antithrombotic drugs. J Clin Invest. 2001 Jun 15;107(12):1591-8.

Cannon, CP. Effectiveness of clopidogrel versus aspirin in preventing acute myocardial infarction in patients with symptomatic atherothrombosis (CAPRIE trial). Am J Cardiol. 2002;90:760.

Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. The Lancet. 2001 Aug 18;358(9281):527-33.

Steinhubl SR, Berger PB, Mann III JT, Fry ET, DeLago A, Wilmer C, et al. Credo Investigators. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. Jama. 2002 Nov 20;288(19):2411-20.

Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. New England J Med. 2005 Mar 24;352(12):1179-89.

Clopidogrel and Metoprolol in Myocardial Infarction Trial. Available at: http://www.commit-ccs2.org. Accessed 24 March 2005.

Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, et al. Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study. JAMA. 2005 Sep 14;294(10):1224-32.

Yusuf, S, Zhao, F, Mehta, SR. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001 Aug 16;345(7):494-502.

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Published

2018-07-23

How to Cite

Patra, V., & Ulchala, V. E. (2018). Role of clopidogrel in addition to aspirin in the prevention of recurrent ischaemic events in acute coronary syndrome with ST-segment elevation. International Journal of Basic & Clinical Pharmacology, 7(8), 1506–1511. https://doi.org/10.18203/2319-2003.ijbcp20183002

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Original Research Articles