Double Loading Dose And Maintenance Dose Clopidogrel In Patients With Acute Coronary Syndrome Comparedshort-term Effect Of Percutaneous Coronary Angioplasty

Objective Comparison of the preoperative and postoperative short-term effects of double loading dose and maintenance dose of clopidogrel in patients with acute coronary syndromes who treated with percutaneou coronary intervention(PCI). And we assessed the efficacy and safety of double loading dose and maintenance dose of clopidogrel.Methods In this study, we selected 206 patients with acute coronary syndrome who treated with Drug-eluting stent (DES) implantation, all subjects were selected from the department of cardiology of the First People's Hospital of Jining City, and randomly divided into A group(double dose group)(n=100)and B group (conventional dose group) (n=106). A group was given preoperative aspirin 300mg, clopidogrel 600mgand given postoperative aspirin 150mg/day for 30 days, After 30 days all patients received 75mg/day of clopidogrel treatment until after one year. B group was given 300mg of aspirin and clopidogrel before PCI, and continuing treated with 75mg/day of clopidogrel in the maintenance of the original dose of preoperative afterPCI. All patients were followed up with the occurrences of major adverse cardiac events[MACE which including cardiac death, fatal or nonfatal myocardial infarction (MI) and target vessel revascularization (TVR)]and hemorrhage. The hemorrhage events were classified according to the Thrombolysis in Myoxardial Tnfarction Trial(TIMI). Major hemorrhage events:1. massive bleeding leading to death; 2. retroperitoneal, intracranial or retinal hemorrhage; 3. Hemoglobin decreased more than 50g/L (or the hematocrit declined more than 15%). Intracranial hemorrhage was diagnosised by CT or MRI. Mild hemorrhage events: any clinical hemorrhage events but no reaching the diagnosis standard of major hemorrhage events(eg. Epistaxis, ecchymosis, hematoma, or gross hematuria), and hemoglobin decreased more than 30g/L (or the hematocrit declined more than 10%).Results All patients were treated successfully for PCI. One case in the conventional dose group was sudden death considering due to the sub-acute stent thrombosis outside the hospital after seven days for PCI. The remaining patients all completed the clinical follow-up. In-stent resrenosis was found in 2 patients by coronary angiography and both of them were successfully implemented TVR. Two cases of TVR were diabetic patients. This suggests that diabetes mellitus might be an independent risk factor of ISR. However, there are only few cases in our study and it yields to be further study. The MACE were significantly decreased in the double-dose group comparing with the conventional dose group, and significant difference was found; No significant difference in hemorrhage events, but there is an increasing trend of hemorrhage in double-dose group. No statistically significant were found in major hemorrhage events and mild hemorrhage events between two grou(χ2=0.511,P=0.475).Conclusion Preoperative double load of clopidogrel 600mg and postoperative maintenance dose 150mg/day for 30 days can reduce the occurrences of MACE in the patients who suffering ACS treated with PCI, and this treatment does not increase the incidence of hemorrhag events.