In addition to standart treatment of reperfusion, effect of application of increasing loading doases of clopidogrel on reperfusion and HS-CRP in patients with acute myocardial infarction

Coronary artery disease and one of its subgroups, acute ST elevation myocardial infarction (ASTEMI), are the leading cause of the deaths in all over the world and in our country. The extend of myocardial necrosis after acute myocardial infarction (AMI) is one of main causes of death and poor prognosis. Because of this, thrombolytics, percutaneous intervention, surgical methods and non-thromboliytic drug treatments used in the providing reperfusion have great importance. When considering this purpose and the ease of handling, the most commonly fibrinolytic treatment is used. However, the guides has put anti-thrombolytic treatment agents as adjuvant therapy into use of compulsory treatment options. One of the important treatment options in the providing reperfusion is clopidogrel. Clopidogrel is a pre-drug which is converted to its active metabolite by liver and inhibits platelet aggregation and ADP-induced platelet activation taking an important place in responsible pathological process of AMI, prolongs bleeding time and reduces blood viscosity. From this point, whether anti-inflammatory activity presence of clopidogrel had been investigated in studies subjecting its anti-trombotic effect, and clopidogrel has reduced levels of hs-CRP, a strong inflammatory indicator of myositis damage, this was supported in patients with acute coronary syndrome (ACS) by clinical studies. In this study, we amied to compare effects of clopidogrel loading doses at 300 mg, 450 mg, 600 mg in patients with ASTEMI on reperfusion and acute inflammatory process, in addition to standart pharmacologic reperfusion therapy.Total 150 patients with MI with acute ST elevation included in our study and they were grouped equally, according to 300 mg, 450 mg, and 600mg clopidogrel loading doses, in addition to standart pharmacological reperfusion treatment. ECG-evaluations were performed with 30 minutes intervals to 90th minutes, including basal ECG after fibrinolytic treatment. The changes were evaluated in CK, CK-MB levels of firts 24 hours period and in hs-CRP levels of 48th hour.There was no statistically significance found between the demographic characteristics and biochemical parameters of patients. Hs-CRP levels of 2nd group loaded with 450 mg was found lower than 1th group loaded with 300 mg, while the levels of 3th group loaded with 600 mg was found significantly lower than other two groups and the difference between groups was statistically significant (p<0.001). CK-MB peak value of 3th group loaded with 600 mg was significantly lower than other groups. Also CK-MB peak level of 3th group was reached early period and the difference between groups was found significant (p<0.05). When ST segment resolution provison time was compared, it was seen that an early period resolution was achived parallel to increase of clopidogrel loading dose and thus the highest loading doses of ST segment resolution which was the group with loaded 600 mg was reached in a less time than the other groups. The difference between groups was found significant (p<0.001).As a result, when currently recommended 300 mg clopidrogrel loading dose of guieds was compared with 450 mg and 600 mg loading doses in this study, we concluded that levels of reperfusion indicators were obtained earlier and the peak level of hs-CRP was found lower as clopidogrel dose was increased. Starting from this point, we believe that the highest loading 600 mg dose of clopidogrel has provided an earlier supression of inflammation and an earlier reperfusion without causing complication in our study.Keywords: acute myocardial infarction, clopidogrel, hs-CRP, reperfusion