Patients whose occluded arteries were treated with standard fibrinolytic regimen , including Aspirin, following acute myocardial infarction with ST-segment elevation ( STEMI ) were more likely to maintain the patency of the infarct-related artery and to reduce ischemic complications.
A significant proportion of patients receiving fibrinolytic therapy for STEMI have inadequate reperfusion or reocclusion of the infarct-related artery, leading to an increased risk of complications and death.

CLARITY-TIMI 28 Investigators enrolled 3491 patients, 18 to 75 years of age, who presented within 12 hours after the onset of STEMI.

The patients were randomized to receive Clopidogrel ( 300mg loading dose, followed by 75 mg once daily ) or placebo, in addition to fibrinolytic agent, Aspirin, and when appropriate, Heparin.

The primary efficacy end point was a composite of an occluded infarct-related artery on angiography or death or recurrent myocardial infarction before angiography.

The primary efficacy end point was achieved by 21.7 percent in the placebo group and 15.0 percent in the Clopidogrel group.

Investigators found a 36 percent lower risk with Clopidogrel therapy ( P<0.001 ).

After 30 days, Clopidogrel therapy reduced the risk of death from cardiovascular causes, recurrent myocardial infarction, or recurrent ischemia leading to the need for urgent revascularization by 20 percent ( P=0.03).

The rates of major bleeding and intracranial hemorrhage were similar in the two groups.

Clopidogrel ( Plavix ) is an antiplatelet drug, contraindicated in patients with active pathologic bleeding such as peptic ulcer or intracranial hemorrhage.
As with other antiplatelet agents, Clopidogrel should be used with caution in patients who may be at risk of increased bleeding from trauma, surgery, or coadministration with NSAIDs or Warfarin.

Source: The New England Journal of Medicine, 2005

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