الفهرس 
Safety and efficacy of pre-cath reloading of clopidogrel in non-st-segment elevation acute coronary syndromes serca trial
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Abstract
Dual Anti Platelet Therapy (DAPT) including aspirin and a potent P2Y12 receptor inhibitor is the recommended standard treatment for NSTE-ACS patients. However, Clopidogrel is still very prevalently used either for financial or medical restraints for more potent agents. Up to
15% of those on DAPT comprising aspirin + Clopidogrel may experience recurrent ischemic event in the first-year post PCI. There is person-to-person heterogeneity in Clopidogrel efficacy, where hypo-responders are estimated to be at least 25% of the population; and are at higher risk for composite vascular events. On the other hand, there are Clopidogrel hyper-responders who are at higher risk of bleeding events. There is an unresolved dilemma when a patient on uninterrupted DAPT (aspirin and clopidogrel) presents with a new NSTE-ACS, if this patient can not be switched to a more potent P2Y12 inhibitor, should or should not he receive reloading of Clopidogrel (300-
600 mg) at the time of PCI.
Objective: To determine both safety and efficacy of precath reloading of Clopidogrel (300 mg) for
NSTE-ACS patients on uninterrupted Clopidogrel use.
Methods: This study randomized 50 patients presenting with NSTE-ACS and are on uninterrupted Clopidogrel therapy into two groups Reloading (received 300 mg Clopidogrel at time of PCI) and maintenance group (received the daily maintenance dose only).
Results: Reloading group showed numerically higher initial TIMI flow, were numerically less likely to have large thrombus burden and were more likely to be treated by PCI compared to the maintenance only group who were more likely to have CAG only and/or be referred for CABG. Reloading was associated with numerically lower needs for extended IV infusion of Tirofiban post PCI. Meanwhile, reloading did not confer any excess bleeding risk.
Conclusion: In patients presenting with NSTE-ACS while being on uninterrupted Clopidogrel therapy and who have restraints to safe switching to a more potent P2Y12 inhibitor, Reloading by
300mg of Clopidogrelat at the time of PCI improved coronary patency, reduced ischaemic endpoints, without increasing the risk of bleeding.