Benefits of clopidogrel in patients undergoing coronary stenting significantly depend on loading dose: Evidence from a meta-regression - 09/08/11
, Marzia Lotrionte, MD b, Pierfrancesco Agostoni, MD c, Marco Valgimigli, MD, PhD d, Antonio Abbate, MD e, Giuseppe Sangiorgi, MD f, Claudio Moretti, MD a, Imad Sheiban, MD aRésumé |
Background |
Clopidogrel is an established alternative to ticlopidine in addition to aspirin after coronary stenting because of its safety, but its optimal initial dosing is unclear. We performed a systematic review and meta-regression of randomized clinical trials comparing clopidogrel versus ticlopidine, focusing on clopidogrel front-loading.
Methods |
PubMed was searched for pertinent studies (updated August 2006). Random-effect odds ratios (ORs) with 95% CIs were computed for death or nonfatal myocardial infarction, and weighted least squares random-effect meta-regression was performed to explore the impact of loading versus nonloading clopidogrel scheme.
Results |
We retrieved 7 trials (3382 patients, average follow-up of 7 months). In 5 studies, both clopidogrel and ticlopidine were started with a loading dose, in 1 trial clopidogrel was administered without loading, and in 1 trial clopidogrel could be administered with or without loading. Overall analysis (P for heterogeneity = .02) showed similar results for clopidogrel and ticlopidine (OR 0.90, 95% CI 0.44-1.84, P = .77). In studies administering clopidogrel with loading, this treatment was, however, significantly better than ticlopidine (OR 0.60, 95% CI 0.36-0.99, P = .05). This significant interaction between clopidogrel loading and its superiority in comparison with ticlopidine was also formally confirmed by meta-regression (β = −0.64, P = .012).
Conclusions |
This work supports the superiority of a clopidogrel regimen including an initial loading dose in comparison with ticlopidine in patients undergoing coronary stenting.
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| This study is part of a senior investigator project of the Center for Overview, Meta-analysis, and Evidence-based Medicine Training (COMET) based in Turin, Italy (www.comet.gs): last accessed on Febrauary 5, 2007. Dr. Biondi-Zoccai reports having received lecture fees from Bristol Myers Squibb (New York, NY). |
Vol 153 - N° 4
P. 587-593 - avril 2007 Retour au numéro
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