Další formáty:
BibTeX
LaTeX
RIS
@article{964656,
author = {Mehta, Shamir R. and Bassand, JeanandPierre and Chrolavicius, Susan and Diaz, Rafael and Eikelboom, John W. and Fox, Keith A. A. and Granger, Christopher B. and Jolly, Sanjit and Joyner, Campbell D. and Rupprecht, HansandJurgen and Widimsky, Petr and Afzal, Rizwan and Pogue, Janice and Yusuf, Salim and Kala, Petr},
article_number = {10},
keywords = {ST-SEGMENT ELEVATION; MYOCARDIAL-INFARCTION; ANTIPLATELET THERAPY; PLATELET INHIBITION; EUROPEAN-SOCIETY; CONTROLLED TRIAL; UNSTABLE ANGINA; DOUBLE-BLIND; EVENTS CURE; TASK-FORCE},
language = {eng},
issn = {0028-4793},
journal = {New England Journal of Medicine},
title = {Dose Comparisons of Clopidogrel and Aspirin in Acute Coronary Syndromes},
volume = {363},
year = {2010}
}
TY - JOUR
ID - 964656
AU - Mehta, Shamir R. - Bassand, Jean-Pierre - Chrolavicius, Susan - Diaz, Rafael - Eikelboom, John W. - Fox, Keith A. A. - Granger, Christopher B. - Jolly, Sanjit - Joyner, Campbell D. - Rupprecht, Hans-Jurgen - Widimsky, Petr - Afzal, Rizwan - Pogue, Janice - Yusuf, Salim - Kala, Petr
PY - 2010
TI - Dose Comparisons of Clopidogrel and Aspirin in Acute Coronary Syndromes
JF - New England Journal of Medicine
VL - 363
IS - 10
SP - 930-942
EP - 930-942
SN - 00284793
KW - ST-SEGMENT ELEVATION
KW - MYOCARDIAL-INFARCTION
KW - ANTIPLATELET THERAPY
KW - PLATELET INHIBITION
KW - EUROPEAN-SOCIETY
KW - CONTROLLED TRIAL
KW - UNSTABLE ANGINA
KW - DOUBLE-BLIND
KW - EVENTS CURE
KW - TASK-FORCE
N2 - Clopidogrel and aspirin are widely used for patients with acute coronary syndromes and those undergoing percutaneous coronary intervention (PCI). However, evidence-based guidelines for dosing have not been established for either agent. METHODS We randomly assigned, in a 2-by-2 factorial design, 25,086 patients with an acute coronary syndrome who were referred for an invasive strategy to either double-dose clopidogrel (a 600-mg loading dose on day 1, followed by 150 mg daily for 6 days and 75 mg daily thereafter) or standard-dose clopidogrel (a 300-mg loading dose and 75 mg daily thereafter) and either higher-dose aspirin (300 to 325 mg daily) or lower-dose aspirin (75 to 100 mg daily). The primary outcome was cardiovascular death, myocardial infarction, or stroke at 30 days. RESULTS The primary outcome occurred in 4.2% of patients assigned to double-dose clopidogrel as compared with 4.4% assigned to standard-dose clopidogrel (hazard ratio, 0.94; 95% confidence interval [CI], 0.83 to 1.06; P = 0.30). Major bleeding occurred in 2.5% of patients in the double-dose group and in 2.0% in the standard-dose group (hazard ratio, 1.24; 95% CI, 1.05 to 1.46; P = 0.01). Double-dose clopidogrel was associated with a significant reduction in the secondary outcome of stent thrombosis among the 17,263 patients who underwent PCI (1.6% vs. 2.3%; hazard ratio, 0.68; 95% CI, 0.55 to 0.85; P = 0.001). There was no significant difference between higher-dose and lower-dose aspirin with respect to the primary outcome (4.2% vs. 4.4%; hazard ratio, 0.97; 95% CI, 0.86 to 1.09; P = 0.61) or major bleeding (2.3% vs. 2.3%; hazard ratio, 0.99; 95% CI, 0.84 to 1.17; P = 0.90). CONCLUSIONS In patients with an acute coronary syndrome who were referred for an invasive strategy, there was no significant difference between a 7-day, double-dose clopidogrel regimen and the standard-dose regimen, or between higher-dose aspirin and lower-dose aspirin, with respect to the primary outcome of cardiovascular death, myocardial infarction, or stroke.
ER -
MEHTA, Shamir R., Jean-Pierre BASSAND, Susan CHROLAVICIUS, Rafael DIAZ, John W. EIKELBOOM, Keith A. A. FOX, Christopher B. GRANGER, Sanjit JOLLY, Campbell D. JOYNER, Hans-Jurgen RUPPRECHT, Petr WIDIMSKY, Rizwan AFZAL, Janice POGUE a Salim YUSUF. Dose Comparisons of Clopidogrel and Aspirin in Acute Coronary Syndromes. \textit{New England Journal of Medicine}. 2010, roč.~363, č.~10, s.~930-942. ISSN~0028-4793.
|
