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BMJ 2005; 330 doi: (Published 07 April 2005) Cite this as: BMJ 2005;330:811
  1. Christopher Martyn, associate editor (

    Clopidogrel helps reduce ischaemic complications in acute MI

    Aspirin and fibrinolytic therapy were established as an effective intervention in acute myocardial infarction more than a decade ago, although reperfusion fails to occur in about 20% of treated patients. Improvements have been slow in coming. Antiplatelet therapy with glycoprotein IIb/IIIa inhibitors improved rates of reperfusion and reduced reinfarction but at the unacceptable cost of doubling major bleeds. Now a randomised trial of 3491 patients, all 75 years and under, with ST elevation myocardial infarction finds that the addition of clopidogrel to a standard fibrinolytic regimen improves the patency rate of the artery whose occlusion caused the infarct and reduces ischaemic complications without an increase in adverse events.


    The primary endpoint was a composite of occlusion of the relevant artery at angiography, 4-8 days later, or death or further infarction before angiography. It occurred in 21.7% of the placebo group but only 15% of the …

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