Abstract 15660: Clopidogrel Reloading for Acute Myocardial Infarction Patients Already on Clopidogrel Therapy: Insights From ACTION Registry - Get With the Guidelines
Introduction: Guidelines recommend an early loading dose of a P2Y12 receptor inhibitor for STEMI and NSTEMI patients, yet whether a loading dose is needed for patients already on clopidogrel therapy is unclear.
Methods: We examined STEMI and NSTEMI patients on clopidogrel therapy on admission and without contraindications to cardiac catheterization in the ACTION Registry GWTG from 2009 to 2014. We used inverse probability weighted propensity adjustment to compare in-hospital mortality and major bleeding risks between patients reloaded in the first 24 hours with 300-600mg of clopidogrel vs. those continued on a maintenance (<300 mg) dose without reloading.
Results: Of 56,327 patients already on clopidogrel, 19,513 (35%) received a loading dose of clopidogrel within the first 24 hours of admission. Patients who were reloaded were younger (median 65 vs. 68 years), less likely to be female (33% vs. 38%) and to have cardiovascular risk factors such as diabetes, prior MI, and prior coronary revascularization. STEMI patients already on clopidogrel therapy were more likely to receive a loading dose than NSTEMI patients (76% vs. 26%, p<0.001). Among STEMI patients, clopidogrel reloading was associated with lower unadjusted and adjusted risks of in-hospital mortality compared with those continued on clopidogrel without reloading, however no significant mortality difference was observed among NSTEMI patients (Table). Risk of major bleeding was not significantly different between patients with and without clopidogrel reloading regardless of MI type.
Conclusion: Despite limited supporting evidence, clopidogrel reloading occurs frequently among patients who present with MI already on clopidogrel therapy, particularly among STEMI patients. We did not observe increased bleeding risk with clopidogrel reloading. The finding of lower mortality associated with clopidogrel reloading among STEMI patients warrants further investigation.
Author Disclosures: J.A. Doll: None. S. Li: None. K. Chiswell: None. M. Kosiborod: Research Grant; Significant; AHA, Gilead Sciences, Genentech, Sanofi-Aventis, Eisai. Consultant/Advisory Board; Modest; Eli Lilly, Regeneron, Takeda, Edwards Lifesciences, Gilead Sciences, Roche, Genentech. Consultant/Advisory Board; Significant; AstraZeneca, Amgen. B.M. Scirica: Research Grant; Modest; AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Johnson and Johnson, Bayer Healthcare, Gilead, Eisai, Merck. Consultant/Advisory Board; Modest; AstraZeneca, Boehringer-Ingelheim, GEHealthcare, Gilead, Lexicon, Arena, Eisai, St. Jude’s Medical, Forest Pharmaceuticals, Bristol-Myers Squibb, Boston Clinical Research Institute, Covance, Elsevier Practice Update Cardiology. M.T. Roe: Research Grant; Modest; Eli Lilly, Janssen Pharmaceuticals, Sanofi-Aventis, Daiichi-Sankyo, Familial Hypercholesterolemia Foundation, Ferring Pharmaceuticals. Honoraria; Modest; Amgen, Bristol Myers Squibb. Consultant/Advisory Board; Modest; Eli Lilly, Elsevier Publishers, PriMed. Consultant/Advisory Board; Significant; AstraZeneca, Merck, Amgen, Boehringer-Ingelheim. W.Y. Tracy: Research Grant; Modest; AstraZeneca, Boston Scientific, Bristol Myers Squibb, Daiichi Sankyo, Gilead Sciences, GlaxoSmithKline, Regeneron Pharmaceuticals. Consultant/Advisory Board; Modest; AstraZeneca, Eli Lilly, Premier.
- © 2015 by American Heart Association, Inc.