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Findings Support Clopidogrel Guideline Recommendations

Last Updated: May 20, 2009.

The use of clopidogrel in patients with non-ST-segment elevation acute coronary syndromes is associated with suitable ischemic reduction and bleeding outcomes to support its use before cardiac catheterization, even if patients should need coronary artery bypass grafting, according to research published in the May 26 issue of the Journal of the American College of Cardiology.

WEDNESDAY, May 20 (HealthDay News) -- The use of clopidogrel in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is associated with suitable ischemic reduction and bleeding outcomes to support its use before cardiac catheterization, even if patients should need coronary artery bypass grafting (CABG), according to research published in the May 26 issue of the Journal of the American College of Cardiology.

Ramin Ebrahimi, M.D., of the University of California in Los Angeles, and colleagues analyzed data from 1,520 patients with NSTE-ACS who underwent CABG. Roughly 50 percent received clopidogrel before the procedure; a five-day clopidogrel washout period was recommended before surgery.

In multivariable analysis, the researchers found that the use of clopidogrel before CABG was associated with reduced 30-day composite ischemia, including death, myocardial infarction, or unplanned revascularization (odds ratio, 0.67). Clopidogrel was not associated with increased major bleeding after the procedure. However, patients receiving clopidogrel had longer median hospitalization (12.0 versus 8.9 days).

"Despite the known benefits of early clopidogrel administration, even on initial hospital presentation and before coronary angiography, this practice is far from universal. The data presented by Ebrahimi et al. support the current American College of Cardiology/American Heart Association guideline recommendations, and hopefully this may sway those who continue to withhold early clopidogrel despite its safety and proven efficacy," conclude the authors of an accompanying editorial.

Most of the study authors and one of the editorial authors reported financial relationships with a number of pharmaceutical companies, including Sanofi-Aventis and Bristol-Meyers Squibb.

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