Abstract | BACKGROUND: METHODS AND RESULTS: In EARLY-ACS, clopidogrel use and timing were determined by treating physicians, but randomization to early eptifibatide versus placebo was stratified by the intent to use upstream clopidogrel. Among 9166 non-ST-elevation acute coronary syndrome patients who underwent coronary angiography, intent to use upstream clopidogrel was declared in 6895 (75%), and 7068 (77%) received upstream clopidogrel. After multivariable adjustment, intended upstream clopidogrel use did not differentially influence the effect of early eptifibatide on the primary end point of 96-hour death/ myocardial infarction/recurrent ischemia requiring urgent revascularization/thrombotic bailout (interaction P=0.988). Early eptifibatide use reduced 30-day death/ myocardial infarction among patients with intended upstream clopidogrel (adjusted odds ratio 0.85; 95% confidence interval 0.73 to 0.99) but not among those without intended upstream clopidogrel use (adjusted odds ratio 1.02; 95% confidence interval 0.80 to 1.30). However, the clopidogrel by randomized treatment interaction term was not significant (P=0.23). Thrombolysis in Myocardial Infarction major bleeding risk was increased with early eptifibatide in the setting of upstream clopidogrel use. Results were similar using actual clopidogrel treatment strata. CONCLUSIONS: Routine early eptifibatide use, compared with delayed provisional use, may be associated with lower 30-day ischemic risk in non-ST-elevation acute coronary syndrome patients also treated with clopidogrel before angiography. The benefit-risk ratio of intensive platelet inhibition with combined early use of antiplatelet agents needs further evaluation in prospective randomized trials.
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Authors | Tracy Y Wang, Jennifer A White, Pierluigi Tricoci, Robert P Giugliano, Uwe Zeymer, Robert A Harrington, Gilles Montalescot, Stefan K James, Frans Van de Werf, Paul W Armstrong, Eugene Braunwald, Robert M Califf, L Kristin Newby |
Journal | Circulation
(Circulation)
Vol. 123
Issue 7
Pg. 722-30
(Feb 22 2011)
ISSN: 1524-4539 [Electronic] United States |
PMID | 21300952
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Peptides
- Platelet Aggregation Inhibitors
- Platelet Glycoprotein GPIIb-IIIa Complex
- Clopidogrel
- Eptifibatide
- Ticlopidine
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Topics |
- Acute Coronary Syndrome
(diagnosis, drug therapy, epidemiology)
- Clopidogrel
- Coronary Angiography
- Drug Therapy, Combination
- Electrocardiography
- Eptifibatide
- Hemorrhage
(chemically induced, epidemiology)
- Humans
- Middle Aged
- Multivariate Analysis
- Myocardial Ischemia
(diagnosis, drug therapy, epidemiology)
- Peptides
(administration & dosage, adverse effects)
- Platelet Aggregation Inhibitors
(administration & dosage, adverse effects)
- Platelet Glycoprotein GPIIb-IIIa Complex
(antagonists & inhibitors)
- Risk Factors
- Ticlopidine
(administration & dosage, adverse effects, analogs & derivatives)
- Treatment Outcome
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