In MI Clopidogrel reloading does not increase risk of in-hospital major bleeding or mortality

Clopidogrel reloading occurs most frequently in patients with acute myocardial infarction (MI) who are already taking clopidogrel, particularly for STEMI.Results from a recent study published in the European Heart Journal has now found that clopidogrel reloading does not cause an increased risk of in-hospital major bleeding or mortality.

Using data from ACC's ACTION Registry-GWTG, Jacob A. Doll, MD, et al., analyzed 51,524 patients who were admitted to 735 PCI-capable hospitals between July 2009 and December 2014. Approximately 39 percent of the study population presented with STEMI, while 61 percent presented with NSTEMI. Only 9 percent of STEMI patients used pre-admission P2Y12 inhibitors, whereas 19 percent of NSTEMI patients did. The authors note that "clopidogrel was the most common agent (91.9 percent), though rates of clopidogrel use declined slightly in later years in concert with increasing use of prasugrel and ticagrelor." In fact, they excluded 4,803 patients for switching to one of these two P2Y12 inhibitors during the study period. Of those taking clopidogrel, 38 percent were reloaded with a dose ?300 mg upon presentation. Majority of STEMI patients (76 percent) received a loading dose, while only a quarter of NSTEMI patients were reloaded.

The authors note that "clopidogrel was the most common agent (91.9 percent), though rates of clopidogrel use declined slightly in later years in concert with increasing use of prasugrel and ticagrelor." In fact, they excluded 4,803 patients for switching to one of these two P2Y12 inhibitors during the study period.The researchers suggest further investigation with a prospective randomized study to "determine if this should be the preferred treatment strategy for this common clinical scenario."