6,8 Currently, the 300-mg loading dose of clopidogrel given at least 6 hours before the procedure represents the conventional antiplatelet regimen before percutaneous intervention.
![loading dose loading dose](https://boomer.org/c/php/Fig2504.gif)
Use of clopidogrel is associated with higher platelet inhibition, lower adverse events after intervention, and a better safety profile as compared with ticlopidine. Accordingly, platelet inhibition with a thienopyridine (ticlopidine or clopidogrel) 5,6 or with glycoprotein IIb/IIIa receptor antagonists 4,7 has significantly reduced periprocedural myocardial injury and cardiac events, primarily in higher-risk patients. Platelet reactivity plays a key role in the pathogenesis of ischemic complications after coronary angioplasty. These results may influence practice patterns with regard to antiplatelet therapy before percutaneous revascularization. An incremental benefit was observed in patients randomized to the 600-mg dose who were receiving statins, with an 80% risk reduction.Ĭonclusions- Pretreatment with a 600-mg loading dose of clopidogrel 4 to 8 hours before the procedure is safe and, as compared with the conventional 300-mg dose, significantly reduced periprocedural MI in patients undergoing percutaneous coronary intervention. At multivariable analysis, the high loading regimen was associated with a 50% risk reduction of MI (OR 0.48, 95% CI 0.15 to 0.97, P=0.044). Safety end points were similar in the 2 arms. Peak values of all markers were significantly lower in patients treated with the 600-mg regimen ( P≤0.038). The primary end point occurred in 4% of patients in the high loading dose versus 12% of those in the conventional loading dose group ( P=0.041) and was due entirely to periprocedural MI. The primary end point was the 30-day occurrence of death, myocardial infarction (MI), or target vessel revascularization.
![loading dose loading dose](https://i.ytimg.com/vi/az69e1aoSms/maxresdefault.jpg)
Creatine kinase MB, troponin I, and myoglobin levels were measured at baseline and at 8 and 24 hours after intervention. Methods and Results- A total of 255 patients scheduled to undergo percutaneous coronary intervention were randomized to a 600-mg (n=126) or 300-mg (n=129) loading regimen of clopidogrel given 4 to 8 hours before the procedure. Although observational data have suggested that pretreatment with a high loading dose of clopidogrel may be more effective than a conventional dose, this hypothesis has never been tested in a randomized trial.
![loading dose loading dose](https://doseme-rx.com/wp-content/uploads/2018/08/vanc-loading-dose-740px-1.jpg)