TAILIEUCHUNG - Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation

A substantial proportion of patients receiving fibrinolytic therapy for myocardial infarction with ST-segment elevation have inadequate reperfusion or reocclusion of the infarct-related artery, leading to an increased risk of complications and death. methods We enrolled 3491 patients, 18 to 75 years of age, who presented within 12 hours after the onset of an ST-elevation myocardial infarction and randomly assigned them to receive clopidogrel (300-mg loading dose, followed by 75 mg once daily) or placebo. Patients received a fibrinolytic agent, aspirin, and when appropriate, heparin (dispensed according to body weight) and were scheduled to undergo angiography 48 to 192 hours after the start of study medication | Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation Marc S. Sabatine . . Christopher P. Cannon . C. Michael Gibson . Jose L. López-Sendón . Gilles Montalescot . Pierre Theroux . Marc J. Claeys . . Frank Cools . Karen A. Hill . Allan M. Skene . Carolyn H. McCabe . and Eugene Braunwald . for the CLARITY-TIMI 28 Investigators abstract background A substantial proportion of patients receiving fibrinolytic therapy for myocardial infarction with ST-segment elevation have inadequate reperfusion or reocclusion of the infarct-related artery leading to an increased risk of complications and death. methods We enrolled 3491 patients 18 to 75 years of age who presented within 12 hours after the onset of an ST-elevation myocardial infarction and randomly assigned them to receive clopidogrel 300-mg loading dose followed by 75 mg once daily or placebo. Patients received a fibrinolytic agent aspirin and when appropriate heparin dispensed according to body weight and were scheduled to undergo angiography 48 to 192 hours after the start of study medication. The primary efficacy end point was a composite of an occluded infarct-related artery defined by a Thrombolysis in Myocardial Infarction flow grade of0 or 1 on angiography or death or recurrent myocardial infarction before angiography. results The rates of the primary efficacy end point were percent in the placebo group and percent in the clopidogrel group representing an absolute reduction of percentage points in the rate and a 36 percent reduction in the odds of the end point with clopidogrel therapy 95 percent confidence interval 24 to 47 percent P . By 30 days clopidogrel therapy reduced the odds of the composite end point of death from cardiovascular causes recurrent myocardial infarction or .

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