Clopidogrel versus ticlopidine after intracoronary stent placement

Peter B. Berger, Malcolm R. Bell, Charanjit Rihal, Henry Ting, Gregory Barsness, Kirk Garratt, Victoria Bellot, Verghese Mathew, Steve Melby, Lavon Hammes, Diane Grill, David Holmes

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Abstract

OBJECTIVES: The study compared the safety and efficacy of ticlopidine with clopidogrel in patients receiving coronary stents. BACKGROUND: Stent thrombosis is reduced when ticlopidine is administered with aspirin. Clopidogrel is similar to ticlopidine in chemical structure and function but has fewer side effects; few data are available about its use in stent patients. METHODS: We compared 30-day event rates in 500 consecutive coronary stent patients treated with aspirin and clopidogrel (300 mg loading dose immediately prior to stent placement, and 75 mg/day for 14 days) to 827 consecutive stent patients treated with aspirin and ticlopidine (500 mg loading dose and 250 mg twice daily for 14 days). RESULTS: Patients treated with clopidogrel had more adverse clinical characteristics including older age, more severe angina, and more frequent infarction within the prior 24 h. Nonetheless, mortality was 0.4% in clopidogrel patients versus 1.1% in ticlopidine patients; nonfatal myocardial infarction occurred in 0% versus 0.5%, stent thrombosis in 0.2% versus 0.7%, bypass surgery or repeat angioplasty in 0.4% versus 0.5%, and any event occurred in 0.8% versus 1.6% of patients, respectively (p = NS). Based on the observed 30-day event rate of 1.6% with ticlopidine, the statistical power of the study was 43% to detect an even rate of 0.5% with clopidogrel, and 75% to detect an event rate with of 4% with clopidogrel, with a p value of 0.05. CONCLUSIONS: These data indicate that clopidogrel can be safely substituted for ticlopidine in patients receiving coronary stents.

Original languageEnglish (US)
Pages (from-to)1891-1894
Number of pages4
JournalJournal of the American College of Cardiology
Volume34
Issue number7
DOIs
StatePublished - Dec 1999

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clopidogrel
Ticlopidine
Stents
Aspirin
Thrombosis

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Clopidogrel versus ticlopidine after intracoronary stent placement. / Berger, Peter B.; Bell, Malcolm R.; Rihal, Charanjit; Ting, Henry; Barsness, Gregory; Garratt, Kirk; Bellot, Victoria; Mathew, Verghese; Melby, Steve; Hammes, Lavon; Grill, Diane; Holmes, David.

In: Journal of the American College of Cardiology, Vol. 34, No. 7, 12.1999, p. 1891-1894.

Research output: Contribution to journalArticle

Berger, PB, Bell, MR, Rihal, C, Ting, H, Barsness, G, Garratt, K, Bellot, V, Mathew, V, Melby, S, Hammes, L, Grill, D & Holmes, D 1999, 'Clopidogrel versus ticlopidine after intracoronary stent placement', Journal of the American College of Cardiology, vol. 34, no. 7, pp. 1891-1894. https://doi.org/10.1016/S0735-1097(99)00442-8
Berger, Peter B. ; Bell, Malcolm R. ; Rihal, Charanjit ; Ting, Henry ; Barsness, Gregory ; Garratt, Kirk ; Bellot, Victoria ; Mathew, Verghese ; Melby, Steve ; Hammes, Lavon ; Grill, Diane ; Holmes, David. / Clopidogrel versus ticlopidine after intracoronary stent placement. In: Journal of the American College of Cardiology. 1999 ; Vol. 34, No. 7. pp. 1891-1894.
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abstract = "OBJECTIVES: The study compared the safety and efficacy of ticlopidine with clopidogrel in patients receiving coronary stents. BACKGROUND: Stent thrombosis is reduced when ticlopidine is administered with aspirin. Clopidogrel is similar to ticlopidine in chemical structure and function but has fewer side effects; few data are available about its use in stent patients. METHODS: We compared 30-day event rates in 500 consecutive coronary stent patients treated with aspirin and clopidogrel (300 mg loading dose immediately prior to stent placement, and 75 mg/day for 14 days) to 827 consecutive stent patients treated with aspirin and ticlopidine (500 mg loading dose and 250 mg twice daily for 14 days). RESULTS: Patients treated with clopidogrel had more adverse clinical characteristics including older age, more severe angina, and more frequent infarction within the prior 24 h. Nonetheless, mortality was 0.4{\%} in clopidogrel patients versus 1.1{\%} in ticlopidine patients; nonfatal myocardial infarction occurred in 0{\%} versus 0.5{\%}, stent thrombosis in 0.2{\%} versus 0.7{\%}, bypass surgery or repeat angioplasty in 0.4{\%} versus 0.5{\%}, and any event occurred in 0.8{\%} versus 1.6{\%} of patients, respectively (p = NS). Based on the observed 30-day event rate of 1.6{\%} with ticlopidine, the statistical power of the study was 43{\%} to detect an even rate of 0.5{\%} with clopidogrel, and 75{\%} to detect an event rate with of 4{\%} with clopidogrel, with a p value of 0.05. CONCLUSIONS: These data indicate that clopidogrel can be safely substituted for ticlopidine in patients receiving coronary stents.",
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T1 - Clopidogrel versus ticlopidine after intracoronary stent placement

AU - Berger, Peter B.

AU - Bell, Malcolm R.

AU - Rihal, Charanjit

AU - Ting, Henry

AU - Barsness, Gregory

AU - Garratt, Kirk

AU - Bellot, Victoria

AU - Mathew, Verghese

AU - Melby, Steve

AU - Hammes, Lavon

AU - Grill, Diane

AU - Holmes, David

PY - 1999/12

Y1 - 1999/12

N2 - OBJECTIVES: The study compared the safety and efficacy of ticlopidine with clopidogrel in patients receiving coronary stents. BACKGROUND: Stent thrombosis is reduced when ticlopidine is administered with aspirin. Clopidogrel is similar to ticlopidine in chemical structure and function but has fewer side effects; few data are available about its use in stent patients. METHODS: We compared 30-day event rates in 500 consecutive coronary stent patients treated with aspirin and clopidogrel (300 mg loading dose immediately prior to stent placement, and 75 mg/day for 14 days) to 827 consecutive stent patients treated with aspirin and ticlopidine (500 mg loading dose and 250 mg twice daily for 14 days). RESULTS: Patients treated with clopidogrel had more adverse clinical characteristics including older age, more severe angina, and more frequent infarction within the prior 24 h. Nonetheless, mortality was 0.4% in clopidogrel patients versus 1.1% in ticlopidine patients; nonfatal myocardial infarction occurred in 0% versus 0.5%, stent thrombosis in 0.2% versus 0.7%, bypass surgery or repeat angioplasty in 0.4% versus 0.5%, and any event occurred in 0.8% versus 1.6% of patients, respectively (p = NS). Based on the observed 30-day event rate of 1.6% with ticlopidine, the statistical power of the study was 43% to detect an even rate of 0.5% with clopidogrel, and 75% to detect an event rate with of 4% with clopidogrel, with a p value of 0.05. CONCLUSIONS: These data indicate that clopidogrel can be safely substituted for ticlopidine in patients receiving coronary stents.

AB - OBJECTIVES: The study compared the safety and efficacy of ticlopidine with clopidogrel in patients receiving coronary stents. BACKGROUND: Stent thrombosis is reduced when ticlopidine is administered with aspirin. Clopidogrel is similar to ticlopidine in chemical structure and function but has fewer side effects; few data are available about its use in stent patients. METHODS: We compared 30-day event rates in 500 consecutive coronary stent patients treated with aspirin and clopidogrel (300 mg loading dose immediately prior to stent placement, and 75 mg/day for 14 days) to 827 consecutive stent patients treated with aspirin and ticlopidine (500 mg loading dose and 250 mg twice daily for 14 days). RESULTS: Patients treated with clopidogrel had more adverse clinical characteristics including older age, more severe angina, and more frequent infarction within the prior 24 h. Nonetheless, mortality was 0.4% in clopidogrel patients versus 1.1% in ticlopidine patients; nonfatal myocardial infarction occurred in 0% versus 0.5%, stent thrombosis in 0.2% versus 0.7%, bypass surgery or repeat angioplasty in 0.4% versus 0.5%, and any event occurred in 0.8% versus 1.6% of patients, respectively (p = NS). Based on the observed 30-day event rate of 1.6% with ticlopidine, the statistical power of the study was 43% to detect an even rate of 0.5% with clopidogrel, and 75% to detect an event rate with of 4% with clopidogrel, with a p value of 0.05. CONCLUSIONS: These data indicate that clopidogrel can be safely substituted for ticlopidine in patients receiving coronary stents.

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