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Clinical Pharmacy Specialist, Internal Medicine, Department of Pharmaceutical Services, St. Elizabeth Health Center, Youngstown, OH; Assistant Clinical Professor of Pharmacy, Department of Pharmacy Practice, Rudolph H Raabe College of Pharmacy, Ohio Northern University, Ada, OH
at time of writing, Clinical Pharmacy Specialist, Critical Care, Department of Pharmaceutical Services, St. Elizabeth Health Center, Youngstown; Adjunct Professor of Pharmacy, Department of Pharmacy Practice, Rudolph H Raabe College of Pharmacy, Ohio Northern University; now, Clinical and Scientific Liaison, Biovail Pharmaceuticals, Inc., Bridgewater, NJ
Reprints: Dr. Longstreth, St. Elizabeth Health Center, Department of Pharmaceutical Services, 1044 Belmont Ave., Youngstown, OH 44501-1790, fax 330/480-2908, kristen_longstreth{at}hmis.org
OBJECTIVE: To review the use of a 600-mg clopidogrel loading dose in patients undergoing percutaneous coronary intervention (PCI).
DATA SOURCES: Human clinical trials and platelet studies available through PubMed (1966–March 2005), bibliographies of pertinent articles, and citations supplied by the drug manufacturer were accessed.
DATA SYNTHESIS: The administration of a 600-mg loading dose of
clopidogrel can decrease the time required for maximum platelet inhibition to
2 hours compared with 
6 hours achieved with 300 mg. This higher loading
dose has been investigated in multiple platelet studies and one observational
report. Several randomized controlled trials have used a 600-mg loading dose;
however, these studies were not designed to evaluate the efficacy and safety
of this loading regimen. To date, only one randomized trial has compared the
600-mg loading dose with a 300-mg loading dose.
CONCLUSIONS: When compared with a conventional loading regimen of 300 mg in lower-risk patients, pretreatment with clopidogrel 600 mg was shown to be more effective in reducing periprocedural events and demonstrated similar safety. Studies are needed to clarify the use of a 600-mg loading dose in higher-risk patients, with concomitant glycoprotein IIb/IIIa receptor antagonism, or when administration is delayed until immediately before or after PCI.
Key Words: clopidogrel, percutaneous coronary intervention
Published Online, April 5, 2005. www.theannals.com, DOI 10.1345/aph.1E463
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  B. T. Ivandic, P. Schlick, P. Staritz, K. Kurz, H. A. Katus, and E. Giannitsis Determination of Clopidogrel Resistance by Whole Blood Platelet Aggregometry and Inhibitors of the P2Y12 Receptor Clin. Chem., March 1, 2006; 52(3): 383 - 388. [Abstract] [Full Text] [PDF]
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