1. Welcome
Ask The Experts
March 24-27, 2007
New Orleans, LA

2. Pretreatment with Thienopyridines
C. Michael Gibson, MS, MD Associate Professor of Medicine Harvard Medical School Chief of Clinical Research Cardiology Division Beth Israel Deaconess Medical Center Boston, MA

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

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

5. 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.

6. Cumulative Holter Monitor Ischemia5 10 15
Bival & post PCI Clop (n=101)
Pre vs post PCI clop
Among bival pts
From 4-24 hrs
HR = 7.28 p = 0.04
Cumulative minutes of ischemia (minutes per patient)
Bival & pre PCI Clop (n=112)
Epti & post PCI Clop (n=220)
Epti & pre PCI Clop (n=217) 6 12 18 24
Hours after end of PCI
CM Gibson ACC 2007

7. 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

8. 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

9. 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

10. 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

11. Question
&
Answer

12. Thank You!
Please make sure to hand in your evaluation and pick up a ClinicalTrialResults.org flash drive