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| |  DG DISPATCH - TCT: Clopidogrel Safer Than Ticlopidine In Thrombosis Prevention By Andrew Bowser Special to DG News WASHINGTON, D.C. -- September 23, 1999 -- Interventional cardiologists are still somewhat at odds over the use of clopidogrel vesus ticlopidine in blocking ADP-mediated platelet aggregation, despite several observational studies and two recent randomized trials demonstrating the newer agent, clopidogrel, has efficacy similar to ticlopidine and lacks hematological toxicity.
The hesitance to embrace clopidogrel is partially because of data suggesting patients given the agent - without an initial loading dose - had a trend toward a higher event rate, even though the difference was not statistically significant. The anxiety over event rates may subside as further data emerges. Researchers at Lenox Hill Heart and Vascular Institute in New York, N.Y., extended the analysis of those two recent randomized studies, retrospectively comparing the combined 1,465 patients treated with ticlopidine and ASA after stenting and 1,100 patients treated with ASA and clopidogrel between January 1997 and December 1998. In these studies, ticlopidine was given 250 mg twice daily for two weeks, while clopidogrel was given as a 300 mg loading dose followed by 75 mg a day for four weeks. At 30 days’ follow-up, stent thrombosis was not different, although acute thrombosis occurred in 0.7 percent of ticlopidine patients and in none of the clopidogrel patients. Cumulative one-month incidence of death, bypass or myocardial infarction (MI) was 2.4 percent for clopidogrel vs. 3.8 percent for ticlopidine (p = 0.06), stemming primarily from a reduced incidence of MI. Then the investigators selected out the patients that got glycoprotein IIb/IIIa receptor inhibitors (the clopidogrel-treated patients got these more often), and found no significant differences in combined death, CABG and MI, but found that acute thrombosis within the first 24 hours was still marginally lower among clopidogrel-treated patients. More data will be needed to determine whether clopidogrel loading provides superior protection from stent thrombosis within the first 24 hours after treatment, according to Dr. Issam Moussa, speaking at the 11th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), in Washington, D.C. Vessel size was smaller and patients were generally older in the clopidogrel-treated group, leading another expert in the field, Dr. Wayne Batchelor, of Duke University, in Durham N.C., to suggest adjusting the results to account for those two variables would tip the scales even more in favor of clopidogrel.
Related Links: Clopidogrel and Ticlopidine.
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