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PRACTICAL
Platelet Responsiveness to Aspirin and Clopidogrel and Troponin Increment after Coronary intervention in Acute coronary Lesions
Ongoing trial
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Author(s) |
Yong G, Rankin J, Ferguson L, Thom J, French J, Brieger D, Chew DP, Dick R, Eccleston D, Hockings B, Walters D, Whelan A, Eikelboom JW |
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Title(s) |
Randomized trial comparing 600- with 300-mg loading dose of clopidogrel in patients with non-ST elevation acute coronary syndrome undergoing percutaneous coronary intervention: results of the Platelet Responsiveness to Aspirin and Clopidogrel and Troponin Increment after Coronary intervention in Acute coronary Lesions (PRACTICAL) trial |
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Reference(s) |
Am Heart J 2009;157:60.e1–9 |
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Disease |
Acute coronary syndromes |
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Purpose |
To compare the effects of 300 vs 600 mg loading dose of clopidogrel on inhibition of platelet aggregation, myonecrosis and clinical outcomes in patients with non-ST-segment elevation acute coronary syndrome undergoing early PCI, if indicated |
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Study design |
Randomised, open, double-blind, placebo-controlled |
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Follow-up |
1 and 6 months |
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Patients |
256 patients (124 clopidogrel 300 mg, 132 clopidogrel 600 mg), mean age 63 years, with non-ST-segment elevation acute coronary syndrome and ischaemic ECG changes, elevated cardiac troponin or history of coronary heart disease |
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Treatment regimen |
Clopidogrel, 300 mg loading dose in all patients, then clopidogrel, 300 mg, or placebo |
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Results |
ADP-induced platelet aggregation was significantly reduced in the clopidogrel 600 mg group compared to the clopidogrel 300 mg group (49.7% vs 55.7%, absolute difference 5.7%, 95% CI 1.02–10.45). 140 patients (71 clopidogrel 300 mg, 69 clopidogrel 600 mg) underwent PCI. There were no significant differences in the incidence of post-intervention myonecrosis and clinical outcomes |
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Comments |
The trial was stopped early because of slow recruitment and because another large trial comparing 300 mg vs 600 mg clopidogrel loading dose (CURRENT OASIS-7) was commenced |
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