Safety and efficacy of clopidogrel treatment in Japanese patients undergoing drug-eluting stent implantation

Abstract

Background: Clopidogrel has been utilized as an antiplatelet therapy for patients undergoing stent implantation. In the Japanese population, however, the impact of clopidogrel on the occurrence of early adverse events is unknown. This study sought to evaluate procedural major bleeding and myocardial infarction in patients undergoing stent implantation with adjunctive clopidogrel compared with ticlopidine.

Methods and results: The retrospective analysis included 311 patients who had stent implantation between January 2007 and April 2009. The patients were divided into groups with clopidogrel (n=159) and ticlopidine (n=152). Primary endpoint was major bleeding and myocardial infarction at 30 days. The incidence of major bleeding was 4.4% in the clopidogrel group vs. 3.9% in the ticlopidine group (p=0.94). The incidence of myocardial infarction was 3.8% in the clopidogrel group vs. 7.9% in the ticlopidine group (p=0.19). In patients with unstable angina, however, there was a strong trend toward lower incidence of myocardial infarction in patients treated with clopidogrel than those treated with ticlopidine (4.1% vs. 13.3%, p=0.08). The incidence of major bleeding was no different (1.4% vs. 5.3%, p=0.37).

Conclusions: In patients with unstable angina and emergent coronary intervention, adjunctive clopidogrel therapy may have a slight positive impact on the prevention of myocardial infarction without increasing the risk of bleeding complications.