Jacob A Doll1,2, Shuang Li3, Karen Chiswell3, Matthew T Roe3,4, Mikhail Kosiborod5, Benjamin M Scirica6, Tracy Y Wang3,4. 1. Division of Cardiology, VA Puget Sound Health Care System, 1660 S. Columbian Way, S111-CARDIO, Seattle, WA 98108, USA. 2. Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA. 3. Duke Clinical Research Institute, Duke University Medical Center, 7022 North Pavilion, Durham, NC 27715, USA. 4. Division of Cardiology, Department of Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, USA. 5. Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO 64111, USA. 6. TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Abstract
Aims: We sought to determine the association of clopidogrel reloading with in-hospital bleeding and mortality in contemporary practice. Methods and results: We examined clopidogrel reloading for ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients on pre-admission clopidogrel therapy in the ACTION Registry-GWTG from 2009 to 2014. We used inverse probability weighted propensity adjustment to compare in-hospital mortality and major bleeding risks between patients reloaded in the first 24 h with ≥300 mg of clopidogrel vs. those continued on a maintenance (<300 mg) dose. Among the 12 366 patients on pre-admission clopidogrel therapy who were admitted with STEMI, 9369 (75.8%) received a loading dose. Of 39 158 patients with NSTEMI, 10 144 (25.9%) were reloaded. Reloaded patients were younger, had fewer comorbid conditions, and were more likely to be treated with primary PCI (STEMI) or an early invasive strategy (NSTEMI). Risks of major bleeding were not significantly different between patients with and without reloading, whether presenting with STEMI (OR 0.98, 95% CI 0.85-1.13) or NSTEMI (OR 1.00, 95% CI 0.90-1.11). Among STEMI patients, clopidogrel reloading was associated with lower risks of in-hospital mortality (OR 0.80, 95% CI 0.66-0.96), however no significant mortality difference was observed among NSTEMI patients (OR 1.13, 95% CI 0.93-1.37). Conclusion: Clopidogrel reloading occurs frequently among MI patients who are on pre-admission clopidogrel therapy, particularly among STEMI patients. We did not observe increased bleeding or mortality risk with clopidogrel reloading, and therefore reloading could be safe for most MI patients. Published on behalf of the European Society of Cardiology. All rights reserved.
Aims: We sought to determine the association of clopidogrel reloading with in-hospital bleeding and mortality in contemporary practice. Methods and results: We examined clopidogrel reloading for ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients on pre-admission clopidogrel therapy in the ACTION Registry-GWTG from 2009 to 2014. We used inverse probability weighted propensity adjustment to compare in-hospital mortality and major bleeding risks between patients reloaded in the first 24 h with ≥300 mg of clopidogrel vs. those continued on a maintenance (<300 mg) dose. Among the 12 366 patients on pre-admission clopidogrel therapy who were admitted with STEMI, 9369 (75.8%) received a loading dose. Of 39 158 patients with NSTEMI, 10 144 (25.9%) were reloaded. Reloaded patients were younger, had fewer comorbid conditions, and were more likely to be treated with primary PCI (STEMI) or an early invasive strategy (NSTEMI). Risks of major bleeding were not significantly different between patients with and without reloading, whether presenting with STEMI (OR 0.98, 95% CI 0.85-1.13) or NSTEMI (OR 1.00, 95% CI 0.90-1.11). Among STEMI patients, clopidogrel reloading was associated with lower risks of in-hospital mortality (OR 0.80, 95% CI 0.66-0.96), however no significant mortality difference was observed among NSTEMI patients (OR 1.13, 95% CI 0.93-1.37). Conclusion:Clopidogrel reloading occurs frequently among MIpatients who are on pre-admission clopidogrel therapy, particularly among STEMI patients. We did not observe increased bleeding or mortality risk with clopidogrel reloading, and therefore reloading could be safe for most MIpatients. Published on behalf of the European Society of Cardiology. All rights reserved.