Clopidogrel 150 mg/day versus 75 mg/day in patients undergoing percutaneous coronary intervention: a meta-analysis.
J Thromb Haemost. 2011 Jan 21;
Authors: Hao PP, Zhang MX, Li RJ, Yang JM, Wang JL, Chen YG, Zhang Y
Background: Whether an increase in daily oral maintenance dose of clopidogrel may improve clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) is still debated. Objectives: This meta-analysis aimed to estimate the relative effect of a 150- versus 75-mg daily maintenance dosage of clopidogrel on clinical and laboratory end-points in patients undergoing PCI. Methods: We searched electronic and printed sources (up to December 14, 2010) for both randomized control trials and observational studies satisfying the predefined inclusion criteria. Results: We retrieved 12 reports of studies including a total of 23,814 patients. Clopidogrel, 150 mg/day, was associated with significant reductions in major adverse cardiac and/or cerebrovascular events (odds ratio [OR] 0.67; 95% confidence interval [CI]: 0.48 to 0.94), myocardial infarction (OR 0.72; 95% CI: 0.60 to 0.86), target vessel revascularization (OR 0.27; 95% CI: 0.12 to 0.62), and stent thrombosis (OR 0.64; 95% CI: 0.53 to 0.77) and decreased adenosine diphosphate-induced maximal platelet aggregation. However, as compared with 75 mg/day, the 150-mg daily maintenance dosage significantly increased the risk of minor bleeding (OR 1.21; 95% CI: 1.08 to 1.36). Conclusion: As compared with the currently recommended 75-mg/day maintenance dosage of clopidogrel, the 150-mg/day dosage can reduce major adverse cardiac and/or cerebrovascular events but may increase the risk of minor bleeding.
PMID: 21255255 [PubMed - as supplied by publisher]