Comparison of Fixed-Dose Clopidogrel/Asetylsalicylic Acid Combination and Standard Loading Strategy During Percutaneous Coronary Intervention in Chronic Coronary Syndrome.

Background: Dual antiplatelet therapy (DAPT), comprising acetylsalicylic acid and a P2Y12 receptor inhibitor such as clopidogrel, is the cornerstone of management in patients undergoing percutaneous coronary intervention (PCI). While conventional loading doses of acetylsalicylic acid and clopidogrel are well established, there is limited evidence supporting the use of fixed-dose combinations (FDCs) for loading therapy in patients with chronic coronary syndrome (CCS).

Aims: This study aims to evaluate the efficacy and safety of an FDC of clopidogrel and acetylsalicylic acid (75/75 mg, four tablets) compared to the standard loading regimen in patients with CCS undergoing elective PCI.

Methods: In this prospective observational study, patients were divided into two groups based on the antiplatelet loading strategy: conventional loading (acetylsalicylic acid 300 mg and clopidogrel 300-600 mg) and FDC group (four tablets of 75/75 mg). Baseline demographic, clinical, laboratory, and procedural characteristics were compared. The primary outcomes were 1-month rates of major adverse cardiovascular events (MACE), stent thrombosis, bleeding (BARC criteria), and mortality.

Results: A total of 410 patients were included (conventional: 326; FDC: 84). There were no statistically significant differences in baseline demographic or procedural characteristics between the groups. Laboratory findings and 1-month clinical outcomes, including MACE, bleeding, and mortality, were similar (p > 0.05 for all outcomes).

Conclusion: Fixed-dose clopidogrel/acetylsalicylic acid combination may be a feasible and clinically comparable option in carefully selected CCS patients to standard loading in CCS patients undergoing elective PCI. Its use may simplify treatment regimens.