Clopidogrel Preload Prior to PCI: The ARMYDA-4 and ARMYDA-5 Trials
The optimal timing of clopidogrel dosing and administration in the setting of percutaneous coronary intervention (PCI) remains an intense area of investigation. A series of studies -- Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty (ARMYDA) trials -- have evaluated the effects of loading doses of clopidogrel in a broad spectrum of patients undergoing angiography and PCI.
The ARMYDA-2 study demonstrated that a 600-mg clopidogrel loading dose given an average of 6 hours prior to PCI was associated with a 61% risk reduction in the rate of major adverse cardiovascular events compared with patients pre-loaded with only 300 mg prior to PCI.
These results warranted further study in other patient populations. In the ARMYDA-4 trial, the effect of a higher loading dose in patients on chronic clopidogrel therapy was studied. The ARMYDA-5 trial evaluated the effects of preloading prior to angiography vs dosing when patients come in for the procedure. The results from these trials, presented below, yield important implications for the current management of patients, as well as identify key areas that warrant further investigation.
Introduction
The optimal timing of clopidogrel dosing and administration in the setting of percutaneous coronary intervention (PCI) remains an intense area of investigation. A series of studies -- Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty (ARMYDA) trials -- have evaluated the effects of loading doses of clopidogrel in a broad spectrum of patients undergoing angiography and PCI.
The ARMYDA-2 study demonstrated that a 600-mg clopidogrel loading dose given an average of 6 hours prior to PCI was associated with a 61% risk reduction in the rate of major adverse cardiovascular events compared with patients pre-loaded with only 300 mg prior to PCI.
These results warranted further study in other patient populations. In the ARMYDA-4 trial, the effect of a higher loading dose in patients on chronic clopidogrel therapy was studied. The ARMYDA-5 trial evaluated the effects of preloading prior to angiography vs dosing when patients come in for the procedure. The results from these trials, presented below, yield important implications for the current management of patients, as well as identify key areas that warrant further investigation.
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