Clinical pharmacodynamics and long-term efficacy of Talcom vs. Plavix in patients undergoing coronary stent implantation: a randomized study with 5-year follow-up
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Form II clopidogrel bisulfate (Plavix) has been extensively used in patients with acute coronary syndrome. However, the efficacy of form I clopidogrel bisulfate (Talcom) was less investigated. The aim of this study was to investigate the efficacy and safety of Talcom compared with Plavix.
Two hundred and forty-eight patients were recruited after receiving percutaneous coronary intervention (PCI). Participants were randomly assigned to Talcom or Plavix group, and administered with Talcom or Plavix 75 mg od respectively in combination with aspirin 100 mg od for 12 months. Primary endpoints were set as levels of adenosine diphosphate-induced platelet aggregation (PLADP) on the 5th day and at 1 month after randomization. Patients were followed-up for 5 years. Bleeding events and major adverse cardiovascular events (MACE) including cardiac death, non-fatal myocardial infarction, ischemic stroke, target lesion revascularization (TLR), and cardiogenic re-admission were recorded.
On the 5th day and at 1 month after randomization, the antiplatelet effect of Talcom was non-inferior to that of Plavix [PLADP (5th day): 30% (22%, 43%) vs. 33% (22%, 44%), p = 0.007; PLADP (1 month): 29% (19%, 43%) vs. 31% (22%, 43%), p = 0.005]. A total of 208 patients completed the follow-up, the incidences of MACE and bleeding were both comparable, and the MACE-free survival did not differ between the two groups. However, the expenditure was 32% lower for Talcom compared to Plavix during the treatment period.
The antiplatelet effect of Talcom is non-inferior to Plavix, and the clinical efficacy and safety of Talcom and Plavix at 5 years were not significantly different in this study.
KeywordsClopidogrel Plavix Talcom Platelet aggregation Non-inferiority trial
Statement on contributorship and the guarantor
JSL, YSF, TTZ, and JC collected the primary data and undertook the initial data analysis; all authors contributed to the drafting of this manuscript. CJL acts as guarantor.
This study was supported by a grant from the National Natural Foundation of China (Grant No.81170181), a grant from the Jiangsu Province’s Key Provincial Talents Program (ZDRCA2016013), and a Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutes (PAPD).
Compliance with ethical standards
This research was approved by the Research Ethics Board of the First Affiliated Hospital of Nanjing Medical University.
Conflict of interest
The authors have no conflict of interest to declare.
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