1. Emerging Data Regarding the Potential Benefits of Early Initiation of Clopidogrel Among ACS Patients
C. Michael Gibson, M.S., M.D.

2. Inhibition of Platelet Aggregation Following Clopidogrel Administration
Hochholzer W et al. Circulation. 2005;111

3. Clopidogrel Loading Dose Timing and Risk of MACE
Log Odds of Death, MI
or UTVR at 28 Days
Placebo
- 2
Clopidogrel
P = 0.020
for treatment / timing
interaction
- 3
- 4
- 5
- 6 5 10 15 20 25 30
Hours Prior to PCI of Study Drug Loading Dose
J Am Coll Cardiol 2006;47:939–43.

4. 30 Day Primary Endpoint Adverse Events
Influence of Thienopyridine Exposure – PCI pts
30 Day Primary Endpoint Adverse Events
RR [95%CI]
0.81 ( )
RR [95%CI]
0.96 ( )
RR [95%CI]
0.50 ( )
RR [95%CI]
1.07 ( )
RR [95%CI]
1.37 ( )
RR [95%CI]
0.61 ( )
Thienopyridine Exposed
Not Thienopyridine Exposed

5. CURE: Major Bleeding in CABG Patients
Major or life-threatening bleeding w/in 7 days of CABG
P=0.07
P=0.53
Clopidogrel stopped
<5 days
prior to CABG
>5 days
K.Fox et al, ESC 2002

6. ACUITY: Primary Outcomes in CABG Patients
Patients with and without a thienopyridine administered in-hospital prior to CABG
P=0.066
P=0.013
P=0.362
*Heparin=unfractionated or enoxaparin

7. 30 Day Outcomes – CABG Patients by Thienopyridine Status
Patients with and without a thienopyridine administered in-hospital prior to CABG
Thieno (+) n=718
Thieno (-) n=820
P-value
Resource Utilization
Total LOS, median
12.1
9.0
<0.001
Pre-CABG LOS, median
4.6
2.5
Post-CABG LOS, median
6.9
5.8
Bleeding Endpoints
Post CABG Major Bleeding
50.0%
50.5%
0.85
Post CABG Blood transfusions
38.2%
38.0%
0.96
24hr Chest Tube Output (median)
600.0 ml
550.0 ml
0.22