Clinical Research
Acute Coronary Syndrome
A Randomized Comparison of High Clopidogrel Loading Doses in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes: The ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) Trial

https://doi.org/10.1016/j.jacc.2006.04.090Get rights and content
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Objectives

We sought to compare the antiplatelet effects of three clopidogrel loading doses (LDs).

Background

Administration of a 300-mg clopidogrel LD is beneficial in situations requiring rapid platelet inhibition. Whether higher LDs can provide further benefits remains unknown.

Methods

Patients (n = 103) with non–ST-segment elevation acute coronary syndromes were randomized to receive a 300-mg, 600-mg, or 900-mg clopidogrel LD, given on top of other standard therapy (including acetylsalicylic acid). The main outcome measure was inhibition of adenosine diphosphate-induced inhibition of platelet aggregation (IPA); inhibition of platelet activation, inflammatory markers, troponin I release, and major adverse cardiac events also were evaluated; all measures were blindly evaluated.

Results

Compared with the 300-mg LD, greater doses were associated with significantly greater platelet inhibition, with dose-effect relationships observed for onset of action, maximal plateau, 24-h areas under the curves of IPA, and rates of low IPA (<10% at 6 h), using 20 μmol/l major adverse cardiac events. A significant dose-response was also observed for the vasodilator-stimulated phosphoprotein index, a measure of P2Y12receptor inhibition. Similar but nonsignificant trends were observed for troponin release and major adverse cardiac events. Bleeding rates were similar in each group.

Conclusions

In low-to-moderate risk patients with non–ST-elevation acute coronary syndromes, clopidogrel LDs >300 mg provide a faster onset of action, a higher IPA plateau, and greater reductions in platelet activation during the first 24 h. A 900-mg LD may induce a greater antiplatelet effect than 600 mg, when compared with the standard 300-mg regimen. These findings require further clinical confirmation.

Abbreviations and Acronyms

ADP
adenosine diphosphate
ASA
acetylsalicylic acid
AUC
area under the inhibition of platelet aggregation curve
GP
glycoprotein
IPA
inhibition of platelet aggregation
LD
loading dose
LMWH
low molecular weight heparin
MACE
major adverse cardiac events
MFI
median fluorescence intensity
NSTE-ACS
non–ST-segment elevation acute coronary syndrome
PA
platelet aggregation
PAI
plasminogen activator inhibitor
PCI
percutaneous coronary intervention
PGE1
prostaglandin E1
sCD40L
soluble CD40 ligand
VASP
vasodilator-stimulated phosphoprotein
vWF Ag
von Willebrand factor antigen

Cited by (0)

This study was supported by a grant from Sanofi-Aventis and Bristol-Myers Squibb. Some conflict of interest with Sanofi Aventis and BMS exists.

1

Dr. Montalescot, Ms. Bal-dit-SoAllier, Dr. Steg, and Dr. Drouet declare that they have been consultants for and/or have received research grants from Sanofi-Aventis.