Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation

To establish reperfusion within the infarct-related coronary artery, acute myocardial infarction is often treated with a combination of fibrinolytic agents, heparin, and aspirin. Despite this therapy, reperfusion is unsuccessful in some patients and reocclusion occurs in others. The addition of the antiplatelet agent clopidogrel to the regimen substantially improved the rate of reperfusion without a significant increase in bleeding complications. The results of this study should prompt rethinking of the protocol for reperfusion therapy in patients with acute myocardial infarction. Despite therapy with fibrinolytic agents, reperfusion is unsuccessful in some patients and reocclusion occurs in others. The addition of clopidogrel to the regimen substantially improved the rate of reperfusion without a significant increase in bleeding complications. The benefit of fibrinolytic therapy for myocardial infarction with ST-segment elevation is limited by inadequate reperfusion or reocclusion of the infarct-related artery in a sizable proportion of patients. Initial reperfusion fails to occur in approximately 20 percent of patients 1 – 3 and is associated with a doubling of mortality rates. 4 The artery becomes reoccluded in an additional 5 to 8 percent of patients during their index hospitalization, and this event is associated with an increase in mortality rates by a factor of nearly three. 5 Platelet activation and aggregation play a key role in initiating and propagating coronary-artery thrombosis. In the Second . . .