Pretreatment with Clopidogrel is a common practice in all patients (STEMI UA/NSTEMI) undergoing PCI. A freshly pressed systematic review and meta-analysis shows no benefit on pretreatment with Clopidogrel on all mortality causes. The authors concluded that especially low risk patients undergoing elective PCI must be no overtreated questioning the need for pretreatment. A favorable trend is shown only in high-risk STEMI patients undergoing PCI.
Two major RCT trials, examining different antiplatelets agents, ticagrelor ang prasugrel, has been expected to be concluded in 2013, and will shed further light on this issue.
Will be not easy to change practice about a molecule that was been around for so long time, but if also those two new trials will fail the primary end points, pretreatment with antiplatelets agents will be in trouble.
Source:
Bellemain-Appaix A, O’Connor SA, Silvain J, et al. Association of Clopidogrel Pretreatment With Mortality, Cardiovascular Events, and Major Bleeding Among Patients Undergoing Percutaneous Coronary Intervention. A systematic review and meta-analysis.
JAMA 2012; 308:2507-2517.
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