Картинки на тему «C.R.E.D.O. Clopidogrel for the Reduction of Events During Observation» |
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 C.R.E.D.O. Clopidogrel for the Reduction of Events During Observation |
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 C.R.E.D.O |
 C.R.E.D.O |
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C.R.E.D.O. Clopidogrel for the Reduction of Events During Observation
содержание презентации «C.R.E.D.O. Clopidogrel for the Reduction of Events During Observation.ppt»| Сл | Текст | Сл | Текст |
| 1 | C.R.E.D.O. Clopidogrel for the | 12 | C.R.E.D.O. Death, MI and Stroke at 1 |
| Reduction of Events During Observation. | Year. P=.02. 10.5%. -26%. 8.5%. 15. 10. 5. | ||
| Multicenter Multinational (USA, Canada) | Clopid. 1 Mth. Clopid. 1 Year. 0. 0 3 6 9 | ||
| Prospective Randomized Double Blind | 12 Mths. Combined EndPoint Occurrence (%). | ||
| Placebo Controlled Trial. From Steinhubl | 13 | C.R.E.D.O. Death, MI, Stroke at 1 Year | |
| et al, JAMA 2002;228:2411-20. | in Key Subgroups. 0 1/2 4 24 48 Hrs. | ||
| 2 | C.R.E.D.O. Aim of the Study. Safety | 14 | C.R.E.D.O. 1 Year Primary and |
| and efficacy of a loading dose of | Secondary Prespecified EndPoints. Death MI | ||
| Clopidogrel prior to elective PCI Safety | Stroke TVR. 1 Year Clopidogrel. 1 Month | ||
| and efficacy of 1 Year vs 1 Month combined | Clopidogrel. 13.6. 13.1. 8.4. 6.7. 2.3. | ||
| treatment with Clopidogrel 75 mg + ASA | 1.7. 0.9. 0.9. | ||
| after elective PCI. | 15 | C.R.E.D.O. Major Bleedings. 8.8. 6.7. | |
| 3 | C.R.E.D.O. Inclusion Criteria. Pts | 4.8. 3.8. 28 Days 1 Year. More than ? of | |
| with symptomatic CAD scheduled for PCI | major procedural bleedings due to CABG. P | ||
| without contraindications to | = 0.24. P = 0.07. Loading Dose-1 Year | ||
| antithrombotic or antiplatelet treatment | Clopidogrel. 1 Month Clopidogrel. | ||
| or stent implantation and with no ST | 16 | C.R.E.D.O. Conclusions. Prolongation | |
| segment elevation within 24 hrs or planned | of treatment with an ADP inhibitor such as | ||
| staged procedures or recent (<7 days) | clopidogrel beyond 1 month after | ||
| administration of GP IIb-IIIa inhibitors, | PCIreduces the incidence of death/MI at 1 | ||
| clopidogrel or thrombolytics. | year There is a strong trend to reduction | ||
| 4 | C.R.E.D.O. 3-24 hrs before PCI. 28 | of death/MI/urgent TVR at 28 days after a | |
| Days and 1 Year Clinical Follow-Up. 300 mg | loading dose of 300 mg of clopidogrel | ||
| Clopidogrel Loading Dose + ASA 325 mg. | administered at least 6 hrs before PCI. | ||
| Placebo + ASA 325 mg. 75 mg Clopidogrel + | 17 | C.R.E.D.O. Questions and Criticisms. | |
| ASA 325 mg for 1 Year. Placebo + ASA 325 | Did pretreatment interfere with long-term | ||
| mg for 1 Year. GP IIb-IIIa Inhib. (mainly | results? Did the poor compliance to | ||
| Abciximab) on prespecified or Bail-out | long-term treatment with clopidogrel (only | ||
| Indications. Clopidogrel 75 mg + ASA 325 | 63/61% of pts took the study drug) modify | ||
| mg for 1 Month. | results? Can we improve it? Can we reduce | ||
| 5 | C.R.E.D.O. Outcomes. At 28 Days Death, | the excess of bleeding? | |
| MI, Urgent TVR in the per protocol | 18 | Aspirin Dose and Bleeding Events in | |
| population (all pts undergoing PCI) with | CURE. 12563 Pts with non-ST Elevation ACS. | ||
| prespecified secondary analysis of pts | Major or Life Threatening Bleeding Events. | ||
| receiving clopidogrel loading dose or | Aspirin Alone (p=0.057). | ||
| placebo <6 hrs or >6 hrs before PCI | Aspirin/Clopidogrel (p=0.042). 4.63. 4.64. | ||
| At 1 Year Death, MI, Stroke with | 3.77. 3.32. 3.19. 2.82. 2.24. 1.92. ASA | ||
| prespecified secondary endpoints of TVR. | <100 mg 100-150 mg 150-300 mg >300 | ||
| 6 | C.R.E.D.O. Power Calculation based on | mg. From Peters et al EHJ | |
| a Retrospective Analysis of 2450 Pts in | 2002;Suppl.4:510. | ||
| the EPISTENT trial: 28 Days Events. | 19 | C.R.E.D.O. Will a higher loading dose | |
| P<0.01. From Steinhubl et al, JACC | help? 10 + 10 Pts pretreated with 200 mg | ||
| 1998;32:1366-70. 13.4%. 8.9%. 7.5%. No | Aspirin. 0 1/2 4 24 48 Hrs. From Muller et | ||
| Ticlopidine Ticlopidine Expected Pre-PTCA | al, Heart 2001;85:92-93. ADP 20 | ||
| Pre-PTCA for Clopid. Loading (expected | ?mol-induced Aggregation. | ||
| placebo) Dose + 1 Year. | 20 | C.R.E.D.O. Do we still need IIb-IIIa | |
| 7 | C.R.E.D.O. Clinical Characteristics | inhibitors in pts with effective | |
| (I). Clopidogrel Loading Dose + | clopidogrel pretreatment? ISAR- REACT: | ||
| Clopidogrel 1 Year N= 1053. Placebo | after 600 mg loading dose Clopidogrel: | ||
| Loading Dose + Clopidogrel 1 Mo N= 1063. | Randomization to Abciximab or Placebo. | ||
| Age (yrs) 61+5 62+7 NS Male Sex (%) 70.7% | 21 | TOPSTAR Study. 109 Pts with 375 mg | |
| 72.1% NS Diabetes (%) 27.5% 25.4% NS | Clopidogrel and 500 mg ASA 24 Hrs before | ||
| Statins (%) 53.6% 57.5% p=0.07 Ca++ Chan. | PCI. From Bonz et al, JACC 2002;40:662-8. | ||
| Block. (%) 25.5% 29.4% p=0.08 MI 14.3 13.1 | Tirofiban 10 ?g + 18 Hrs Infusion. Placebo | ||
| Indication (%) UAP 52.5 53.1 NS SA 32.8 | bolus + 18 Hrs infusion. 128. 108. 100. | ||
| 32.8 PTCA 85.6 86.2 Treatment (%) Medical | 100. 98. 87. % Platelet Function. 14. 10. | ||
| 8.3 7.6 NS CABG 3.9 4.0. | Prior 30 min 12 Hrs 48 Hrs. | ||
| 8 | C.R.E.D.O. Clinical Characteristics | 22 | TOPSTAR Study. 109 Pts with 375 mg |
| (II). Received >1 Stent (%) 89.7 88.3 | Clopidogrel and 500 mg ASA 24 Hrs before | ||
| NS Total Stent Length (mm) 24.4 23.5 NS GP | PCI. 63%. 40%. Positive Troponin T | ||
| IIb-IIIa Antag. (%) 47.4% 43.3% p=0.08. | (>0.01 ?g/ml). From Bonz et al, JACC | ||
| Clopidogrel Loading Dose + Clopidogrel 1 | 2002;40:662-8. Tirofiban 10 ?g + 18 Hrs | ||
| Year N= 900. Placebo Loading Dose + | Infusion. Placebo bolus + 18 Hrs infusion. | ||
| Clopidogrel 1 Mo N= 915. | 23 | C.R.E.D.O. Is 1 Year Treatment Enough? | |
| 9 | C.R.E.D.O. Death, MI and Urgent TVR at | CHARISMA: 15000 Stable Angina Pts with 42 | |
| 28 Days. NS. 8.3%. -18.5%. 6.8%. 10. 8. 6. | Mths F-Up. 2658 Pts undergoing PCI in the | ||
| Clopid. No Loading. 4. Clopid. Loading. 2. | CURE trial. From Metha et al, Lancet | ||
| 0. 0 Days 7 14 21 28. Combined EndPoint | 2001;358:527-33. Death, MI Kaplan-Meier | ||
| Occurrence (%). | cum. Hazard rates. | ||
| 10 | C.R.E.D.O. Death, MI and Urgent TVR at | 24 | C.R.E.D.O. Questions and Criticisms. |
| 28 Days. P=0.051. -38.6%. 10. 8. 6. 4. | What about cost-effectiveness? Mechanism | ||
| Clopid. No Loading. Clopid. < 6 Hrs | of clinical benefit? prevention of | ||
| Loading Clopid. > 6 Hrs. 2. 0. 0 Days 7 | periprocedural damage, TVR late events and | ||
| 14 21 28. Combined EndPoint Occurrence | non TVR late events Long-term treatment | ||
| (%). | with clopidogrel advised for pts who | ||
| 11 | C.R.E.D.O. Death, MI, Urgent TVR at 28 | receive drug eluting stents (3 mths | |
| Days. | SIRIUS, 6 mths TAXUS). | ||
| C.R.E.D.O. Clopidogrel for the Reduction of Events During Observation.ppt | |||
C.R.E.D.O. Clopidogrel for the Reduction of Events During Observation
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