1. Antiplatelet therapy for STEMI: The Case for Clopidogrel
Sunil V. Rao MD FACC FSCAI
The Duke Clinical Research Institute
Duke University Medical Center

2. Off-label uses of drugs/devices may be discussed
Disclosures
Consultant, Honoraria
The Medicines Company, Terumo Medical, ZOLL
Research funding
Bellerophon
Off-label uses of drugs/devices may be discussed

3. Clopidogrel in STEMI You know how you sound, Mr. Blaine?
Like a man who's trying to convince himself of
something he doesn't believe in his heart.

4. Clopidogrel – preferred in STEMI
Clopidogrel is once daily
Clopidogrel is generic and affordable
Clopidogrel has lower bleeding risk
Clopidogrel has fewer contraindications than some newer P2Y12 inhibitors

5. Compliance higher with QD
Impact of daily dosing frequency on adherence N=10697 pts with atrial fibrillation; QD vs. BID meds
MPR
PDC
PDC – proportion of days covered
MPR – medication possession ratio
1.0
Compliance higher with QD
Laliberte F, et. al. Adv Ther 2012

7. Ticagrelor vs. Clopidogrel in STEMI N=7544 with STEMI
Ticagrelor prevented 42 MIs but at the
Expense of 21 strokes
Steg PG, et. al. Circulation 2010

8. Ticagrelor vs. Clopidogrel in STEMI: Major bleeding N=7544 with STEMI
Steg PG, et. al. Circulation 2010

9. Prasugrel vs. Clopidogrel in STEMI N=3544 patients with STEMI
CV Death/MI/Stroke
CV Death/MI/uTVR
Stent thrombosis
TIMI Major bleeding
Montalescot G, et. al. Lancet 2009

10. Net Clinical Benefit: Bleeding Risk Subgroups
Post hoc analysis
Risk (%)
Yes
+37
Prior Stroke/TIA No
Pint = 0.006
-16
≥75 -1
Age
<75
Pint = 0.18
-16
<60 kg +3
Weight
≥60 kg
Pint = 0.36
-14
-13
0.5 1 2
Prasugrel Better
Clopidogrel Better HR
Wiviott et al. N Engl J Med. 2007;357:2001.

11. Clopidogrel – preferred in STEMI
Clopidogrel is once daily
Clopidogrel is generic and affordable
Clopidogrel has lower bleeding risk
Clopidogrel has fewer contraindications than some newer P2Y12 inhibitors

12. Duke Univ. Medical Center Duke Clinical Research Institute