Clopidogrel as adjunctive antiplatelet therapy during coronary stenting

OBJECTIVES We examined the procedural and 30-day clinical outcomes among pa tients receiving aspirin and either ticlopidine or clopidogrel during coron ary stenting. BACKGROUND Ticlopidine-plus-aspirin has become standard antiplatelet therap y for the prevention of thrombotic complications after coronary stenting. C lopidogrel has a similar mechanism of action as ticlopidine, but both its e fficacy and its safety as a pharmacologic adjunct to coronary stenting have not been well described. METHODS This single-center, prospective analysis examined the in-hospital p rocedural and 30-day clinical outcomes among 875 consecutive patients under going coronary stenting who received adjunctive aspirin and either clopidog rel (n = 514; 58.7%) or ticlopidine (n = 361; 41.3%) therapy. RESULTS Procedural success rates were similar among the clopidogrel- (99.6% ) and ticlopidine-treated patients (99.4%). Subacute stent thrombosis (i.e. , >24 h less than or equal to 30 days) occurred in one clopidogrel-treated (0.2%) and in one ticlopidine-treated (0.3%) patient (p = 0.99). By 30 days following the index procedure, the combined rates of death, nonfatal myoca rdial infarction and need for target vessel revascularization were similar among patients who received either clopidogrel (2.1%) or ticlopidine (1.4%; p = 0.57) therapy. CONCLUSIONS In this analysis the antiplatelet combination therapy of aspiri n-plus-clopidogrel was an effective regimen for preventing thrombotic compl ications and major adverse cardiovascular events among a broad spectrum of patients undergoing coronary artery stenting. (C) 1999 by the American Coll ege of Cardiology.