Clopidogrel 150 vs. 75 mg day-1 in patients undergoing percutaneous coronary intervention: a meta-analysis

Background: Whether an increase in the daily oral maintenance dose of clopidogrel may improve clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) is still debated. Objectives: This meta-analysis aimed to estimate the relative effect of a 150- vs. 75-mg daily maintenance dosage of clopidogrel on clinical and laboratory end-points in patients undergoing PCI. Methods: We searched electronic and printed sources (up to 14 December 2010) for both randomized control trials and observational studies satisfying the predefined inclusion criteria. Results: We retrieved 12 reports of studies including a total of 23 814 patients. Clopidogrel, 150 mg day(-1), was associated with significant reductions in major adverse cardiac and/or cerebrovascular events (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.48-0.94), myocardial infarction (OR, 0.72; 95% CI, 0.60-0.86), target vessel revascularization (OR, 0.27; 95% CI, 0.12-0.62) and stent thrombosis (OR, 0.64; 95% CI, 0.53-0.77) and decreased adenosine diphosphate-induced maximal platelet aggregation. However, as compared with 75 mg day(-1), the 150-mg daily maintenance dosage significantly increased the risk of minor bleeding (OR, 1.21; 95% CI, 1.08-1.36). Conclusion: As compared with the currently recommended 75-mg day(-1) maintenance dosage of clopidogrel, the 150-mg day(-1) dosage can reduce major adverse cardiac and/or cerebrovascular events but may increase the risk of minor bleeding.