High-maintenance-dose clopidogrel in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis.
<h4>Background</h4>Despite routine use of clopidogrel, adverse cardiovascular events recur among some patients undergoing percutaneous coronary intervention (PCI). To optimize antiplatelet therapies, we performed a meta-analysis to quantify the efficacy of high versus standard-maintenanc...
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0078549&type=printable |
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| author | Yu Chen Yachen Zhang Yong Tang Xiaohong Huang Yuquan Xie |
| author_facet | Yu Chen Yachen Zhang Yong Tang Xiaohong Huang Yuquan Xie |
| author_sort | Yu Chen |
| collection | DOAJ |
| description | <h4>Background</h4>Despite routine use of clopidogrel, adverse cardiovascular events recur among some patients undergoing percutaneous coronary intervention (PCI). To optimize antiplatelet therapies, we performed a meta-analysis to quantify the efficacy of high versus standard-maintenance-dose clopidogrel in these patients.<h4>Methods</h4>Randomized controlled trials (RCTs) comparing high (>75 mg) and standard maintenance doses of clopidogrel in patients undergoing PCI were included. The primary efficacy and safety end-points were major adverse cardiovascular/cerebrovascular events (MACE/MACCE) and major bleeding. The secondary end-points were other ischemic and bleeding adverse effects. The pooled odds ratio (OR) for each outcome was estimated.<h4>Results</h4>14 RCTs with 4424 patients were included. Compared with standard-maintenance-dose clopidogrel, high-maintenance-dose clopidogrel significantly reduced the incidence of MACE/MACCE (OR 0.60; 95% CI 0.43 to 0.83), stent thrombosis (OR 0.56; 95% CI 0.32 to 0.99) and target vessel revascularization (OR 0.38; 95% CI 0.20 to 0.74), without significant decrease of the risk of cardiovascular death (OR 0.92; 95% CI 0.74 to 1.13) and myocardial infarction (OR 0.83; 95% CI 0.51 to 1.33). For safety outcomes, it did not significantly increase the risk of major bleeding (OR 0.73; 95% CI 0.41 to 1.32), minor bleeding (OR 1.29; 95% CI 1.00 to 1.66) and any bleeding (OR 1.14; 95% CI 0.91 to 1.43).<h4>Conclusion</h4>High-maintenance-dose clopidogrel reduces the recurrence of most ischemic events in patients post-PCI without increasing the risk of bleeding complications. |
| format | Article |
| id | doaj-art-8273e0c858574194a4401f136e5ef9df |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-8273e0c858574194a4401f136e5ef9df2025-08-20T03:49:55ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-01810e7854910.1371/journal.pone.0078549High-maintenance-dose clopidogrel in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis.Yu ChenYachen ZhangYong TangXiaohong HuangYuquan Xie<h4>Background</h4>Despite routine use of clopidogrel, adverse cardiovascular events recur among some patients undergoing percutaneous coronary intervention (PCI). To optimize antiplatelet therapies, we performed a meta-analysis to quantify the efficacy of high versus standard-maintenance-dose clopidogrel in these patients.<h4>Methods</h4>Randomized controlled trials (RCTs) comparing high (>75 mg) and standard maintenance doses of clopidogrel in patients undergoing PCI were included. The primary efficacy and safety end-points were major adverse cardiovascular/cerebrovascular events (MACE/MACCE) and major bleeding. The secondary end-points were other ischemic and bleeding adverse effects. The pooled odds ratio (OR) for each outcome was estimated.<h4>Results</h4>14 RCTs with 4424 patients were included. Compared with standard-maintenance-dose clopidogrel, high-maintenance-dose clopidogrel significantly reduced the incidence of MACE/MACCE (OR 0.60; 95% CI 0.43 to 0.83), stent thrombosis (OR 0.56; 95% CI 0.32 to 0.99) and target vessel revascularization (OR 0.38; 95% CI 0.20 to 0.74), without significant decrease of the risk of cardiovascular death (OR 0.92; 95% CI 0.74 to 1.13) and myocardial infarction (OR 0.83; 95% CI 0.51 to 1.33). For safety outcomes, it did not significantly increase the risk of major bleeding (OR 0.73; 95% CI 0.41 to 1.32), minor bleeding (OR 1.29; 95% CI 1.00 to 1.66) and any bleeding (OR 1.14; 95% CI 0.91 to 1.43).<h4>Conclusion</h4>High-maintenance-dose clopidogrel reduces the recurrence of most ischemic events in patients post-PCI without increasing the risk of bleeding complications.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0078549&type=printable |
| spellingShingle | Yu Chen Yachen Zhang Yong Tang Xiaohong Huang Yuquan Xie High-maintenance-dose clopidogrel in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. PLoS ONE |
| title | High-maintenance-dose clopidogrel in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. |
| title_full | High-maintenance-dose clopidogrel in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. |
| title_fullStr | High-maintenance-dose clopidogrel in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. |
| title_full_unstemmed | High-maintenance-dose clopidogrel in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. |
| title_short | High-maintenance-dose clopidogrel in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. |
| title_sort | high maintenance dose clopidogrel in patients undergoing percutaneous coronary intervention a systematic review and meta analysis |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0078549&type=printable |
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