Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation.

Authors
Yusuf, S Fox, KAA Tognoni, G Mehta, SR Chrolavicius, S Anand, S Avezum, A Awan, N Bertrand, M Budaj, A Ceremuzynski, L Col, J Commerford, PJ Diaz, R Flather, M Franzosi, MG Gersh, B Grossman, W Halon, DA Hunt, D Joyner, C Karatzas, N Keltai, M Kopecky, S Lewis, BS Maggioni, A Malmberg, K Moccetti, T Morais, J Natarajan, M Paolasso, E Peters, R Piegas, L Pipilis, A Pogue, J Ramos-Corrales, M Rupprecht, HJ Sitkei, E Valentin, V Varigos, J Widimsky, P Wittlinger, T Blumenthal, M Bouthier, J Gaudin, C Hess, T Khurmi, N Sotty, M Copland, I Cracknell, B Demers, C Eikelboom, J Morris, B Pasquale, J Yacyshyn, V Zhao, F Wyse, G Cairns, J Hart, R Hirsh, J Gent, M Ryan, T Wittes, J Guerrero, RA Arias, V Bello, FH Bono, JO Bujan, L Caccavo, A Fernandez, AA Fuselli, JJ Gambarte, AJ Hasbani, EG Marzetti, E Mon, G Nordaby, R Quijano, G Salvati, A San Martin, E Schygiel, P Liprandi, AS Torre, H Tuero, E Amerena, J Bett, JHN Botha, J Buncle, A Careless, D Ewart, A Fagan, A Fitzpatrick, D Garrahy, P Gunawardane, K Hamer, A Hill, A Jepson, N Lane, G LeGood, H Nelson, G Sallaberger, M Tulloch, G Owensby, D Padley, J Rees, D Roberts, K Rosen, D Sampson, J Singh, B Singh, C Taylor, R Thomson, A Walsh, W De Raedt, H Rankin, J Abrantes, JA de Albuquerque, DC Blacher, C Bodanese, LC Carvalho, AC Coutinho, M Dutra, O Esteves, JP Leaes, P Lima, NS Lobo, N Neto, JAM Marino, RL Nicolau, JC Pedrosa, RC Pereira, I Rabelo, W Rabelo, A Ramos, RF Rocha, RM Schramm, EC Serrano, CV Souza, VP Timerman, A Vaz, R Xavier, SS Auger, P Barbin, K Bata, I Bergeron, L Bhargava, RK Bogaty, P Bolduc, P Boyne, T Boyer, L Bozek, B Calmusky, T Chan, YK Cole, D D'Astous, M David, M Davies, T Desjardins, L Dohaney, PB Doody, M Dumont, F Fortin, C Fung, A Galdreault, G Gervais, PB Giannoccaro, JP Gosselin, G Grandmont, D Grover, A Gupta, M Hink, H Hiscock, JG Hutton, D Hynd, JWH Iless, A Kent, C Kitching, A Kouz, S Kwok, K LaForest, M Lee, H Lefkowitz, C Lubelsky, B Ma, P Marquis, JF McCallum, A Major, R May, B Mercier, M Montigny, M Morris, A Nawaz, S Norris, J Pallie, S Panju, A Parekh, P Patterson, C Pesant, Y Pilon, C Rajakumar, ARJ Rebane, T Ricci, J Ruel, M Schuld, R Starra, R Thornley, M Weeks, AS Winkler, LH Wisenberg, G Witt, I Woo, K Yu, E Zadra, R Zaniol, D Bocek, P Branny, M Cepelak, V Gregor, P Groch, L Jansky, P Svitil, P Vaclavicek, A Husted, S Ziegler, B Karhu, A Mustonen, J Nieminen, M Nissinen, K Peuhkurinen, K Tuomainen, P Ylitalo, A Adam, M Amat, G Asward, K Bessede, G Dambrine, P Decoulx, E D'Hautefeuille, B Dujardin, J Fouche, R Fournier, P Haftel, Y Ketelers, JY Lallemant, R Lang, M Leroy, F Richard, M Dippold, W Gronholz, J Harenberg, J Hilpert, C Horacek, T Moritz, A Neuss, H Nitsche, K Ochs, HR Plumer-Schmidt, M Pollock, B Post, G Sauer, M Schmidt, A Schmitt, H Schulze, HO Schuster, P von Leitner, ER Christakos, S Karidis, K Kifnidis, K Papadopoulos, K Symconidis, D Tirologos, A Garai, B Gesztesi, T Heltai, K Herczeg, B Janosi, A Kadar, A Kalo, E Karpati, P Kiss, B Nagy, A Okros, M Poor, F Regos, L Sebo, J Sitkei, E Soltesz, P Stefan, J Szaboki, F Timar, S Varallyay, Z Veres, K Daly, K Cotter, G Marmor, A Nazzal, D Omary, M Reisin, L Rosenfeld, T Shargorodsky, M Shasha, S Smulovitz, A Vered, Z Zimlichman, R Beria, G Bernardi, D Bonfanti, E Ceci, V De Caterina, R De Servi, S DelPinto, M Di Chiara, A Di Pasquale, G Filippucci, L Galli, M Gardinale, E Landoni, MT Martoni, A Mauri, F Maurea, N Meneghetti, P Mennuni, M Murrone, A Pani, A Paolini, E Passarelli, P Pettinati, G Pontillo, B Rossi, L Rossi, R Santini, M Sabino, G Tricoci, P Turazza, FM Diaz, AC Garcia-Sosa, A Santamaria, IH Pons, JL Medecigo, JN Rojo, FJR Diaz, CJS Castro, JT Morales, EV Baldew, S Basart, DCG Bijsterfeld, N Bronzwaer, P Chardon, A den Hartoog, M Heijmen, H Heijmeriks, J Jochemsen, G Klomps, H Landsaat, P Michels, H Moons, A Pieterse, M Sadee, A van Beek, G Van Hessen, M Verheul, J Viergever, E Audeau, M Hills, M Ikram, H Johnstone, M Smart, A Erikssen, J Morstel, T Winther, J Achremczyk, P Baranowska, A Burduk, P Cichon, D Czepiel, A Danielewicz, H Danielewicz, P Dworzanski, W Gessek, J Gorecki, A Gorny, J Janik, K Jedrzejowski, A Kania, G Kawka-Urbanek, T Klaudel, J Kopcik, D Kozlowski, A Krasowski, W Ladach, A Laniec, M Maciejewicz, J Maciejewski, P Majcher, Z Malinowski, S Marczyk, T Miekus, P Myczka, T Ogorek, M Piepiorka, M Religa, K Reszka, Z Rozwodowska, M Smielak-Korombel, W Smiglak, D Spyra, J Stec, S Susol, D Szpajer, M Szymanski, P Szymcyyk-Muszytowska, G Tomzynski, M Ujda, M Wasek, W Waszyrowski, T Wojewoda, P Wnorowska, A Wrobel, P Zadrozny, J Zebrowski, A Zielinski, Z Bastos, JM Cardoso, P Carrageta, M Catarino, C Ferreira, R Gomes, MV Aboo, A Bobak, L Brown, B Cassim, S Harripersadh, S Manga, P Maritz, F Marx, J Myburgh, D Nell, H Okreglicki, A Theron, H Orcajo, NA Colomina, F Echanove, I Guerrer, JG Gomez-Martinez, E Lekuona, I Miralles, L Pasaval, C Rovira, A San Jose, J Llorian, AR Valentin, V Abdon, N Bartholdson, B Basilier, E Johansson, I Kristensson, B Larsson, K Lindell, P Moller, B Rasmanis, G Stjerna, A Tolhagen, K Caduff, B Noseda, G Rossi, A Schmidt, D Zerega, J Carr, K Detrano, R Geer, R Grewal, G Hermany, P Lakkis, N Lewis, WR Pacheco, TR Papuchis, G Puma, J Runckey, S Thadani, U Whitaker, J Adgey, YJA Blackman, D Brack, M Bridges, A Cohen, A Currie, P Duffy, S Findlay, I Goodfellow, J Gray, K Hogg, D Holdright, D Hughes, D Irvine, N Jennings, K Keeling, P Ludman, P Mathew, T McIntyre, P Oliver, R Palmer, N Rodrigues, E Smyth, L Sprigings, D Stephens, J Timmis, A Vincent, R
Citation
S. Yusuf et al., Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation., N ENG J MED, 345(7), 2001, pp. 494-502
Citations number
20
Language
INGLESE
art.tipo
Article
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Journal title
NEW ENGLAND JOURNAL OF MEDICINE
ISSN journal
0028-4793 → ACNP
Volume
345
Issue
7
Year of publication
2001
Pages
494 - 502
Database
ISI
SICI code
0028-4793(20010816)345:7<494:EOCIAT>2.0.ZU;2-8
Abstract
Background: Despite current treatments, patients who have acute coronary sy ndromes without ST-segment elevation have high rates of major vascular even ts. We evaluated the efficacy and safety of the antiplatelet agent clopidog rel when given with aspirin in such patients. Methods: We randomly assigned 12,562 patients who had presented within 24 h ours after the onset of symptoms to receive clopidogrel (300 mg immediately , followed by 75 mg once daily) (6259 patients) or placebo (6303 patients) in addition to aspirin for 3 to 12 months. Results: The first primary outcome -- a composite of death from cardiovascu lar causes, nonfatal myocardial infarction, or stroke -- occurred in 9.3 pe rcent of the patients in the clopidogrel group and 11.4 percent of the pati ents in the placebo group (relative risk with clopidogrel as compared with placebo, 0.80; 95 percent confidence interval, 0.72 to 0.90; P<0.001). The second primary outcome -- the first primary outcome or refractory ischemia -- occurred in 16.5 percent of the patients in the clopidogrel group and 18 .8 percent of the patients in the placebo group (relative risk, 0.86, P<0.0 01). The percentages of patients with in-hospital refractory or severe isch emia, heart failure, and revascularization procedures were also significant ly lower with clopidogrel. There were significantly more patients with majo r bleeding in the clopidogrel group than in the placebo group (3.7 percent vs. 2.7 percent; relative risk, 1.38; P=0.001), but there were not signific antly more patients with episodes of life-threatening bleeding (2.1 percent vs. 1.8 percent, P=0.13) or hemorrhagic strokes. Conclusions: The antiplatelet agent clopidogrel has beneficial effects in p atients with acute coronary syndromes without ST-segment elevation. However , the risk of major bleeding is increased among patients treated with clopi dogrel. (N Engl J Med 2001;345:494-502.) Copyright (C) 2001 Massachusetts M edical Society.