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June 22 2011

Standard- vs High-Dose Clopidogrel After Percutaneous Coronary Intervention—Reply

JAMA. 2011;305(24):2520-2522. doi:10.1001/jama.2011.844

In Reply: Dr Jeong and colleagues compare the GRAVITAS and CURRENT-OASIS 7 trials.1 As they suggest, these trials were markedly different in their design and characteristics of the cohorts that were enrolled. The patients in GRAVITAS had predominantly stable coronary artery disease or low-risk unstable angina with high on-treatment reactivity while receiving clopidogrel after PCI. In contrast, the patients in CURRENT-OASIS 7 presented with acute coronary syndrome prior to intended PCI.1 In both cases, high-dose clopidogrel was not superior to a standard-dose regimen. The modest 0.6% absolute risk reduction for double-dose clopidogrel in the PCI patients in CURRENT-OASIS 7 was not statistically significant according to the interaction P value and is consistent with the marginal pharmacodynamic effect of double-dose clopidogrel in GRAVITAS.