Megumi Taniuchi

Meta-analysis of randomized and registry comparisons of ticlopidine with clopidogrel after stenting

OBJECTIVES We sought to determine whether clopidogrel is at least as efficacious as ticlopidine. BACKGROUND Several trials have supported the enhanced safety and tolerability of clopidogrel compared with ticlopidine after coronary stent deployment. However, none of these individual trials were powered to detect possible differences in the efficacy for reducing ischemic end points. METHODS Published data from trials and registries that compared clopidogrel with ticlopidine in patients receiving coronary stents were pooled, and a formal meta-analysis was performed. The rate of 30-day major adverse cardiac events (MACE), as defined in each trial, was used as the primary end point. RESULTS There were a total of 13,955 patients. The pooled rate of major adverse cardiac events was 2.10% in the clopidogrel group and 4.04% in the ticlopidine group. After adjustment for heterogeneity in the trials, the odds ratio (OR) of having an ischemic event with clopidogrel, as compared with ticlopidine, was 0.72 (95% confidence interval [CI] 0.59 to 0.89, p = 0.002). Mortality was also lower in the clopidogrel group compared with the ticlopidine group-0.48% versus 1.09% (OR 0.55, 95% CI 0.37 to 0.82; p = 0.003). CONCLUSIONS Based on all available evidence from randomized clinical trials or registries, clopidogrel, in addition to better tolerability and fewer side effects, is at least as efficacious as ticlopidine in reducing MACE. This finding may be due to the more rapid onset of an antiplatelet effect seen with the loading dose of clopidogrel, which was used in most of these studies, or to better patient compliance with clopidogrel therapy. Therefore, clopidogrel plus aspirin should replace ticlopidine plus aspirin as the standard antiplatelet regimen after stent deployment.

Expression and possible function of nerve growth factor receptors on Schwann cells

Abstract Nerve growth factor (NGF) is a protein derived from target tissues, which acts via receptors on neurons to produce neurotrophic effects after retrograde transport to the neuronal soma. This two-cell model (Fig. 1) may need to be modified in light of recent data demonstrating that Schwann cells, both during development and after axonal injury in the adult, make NGF and express NGF receptors. The regulation (i.e. suppression) of this expression appears to be by axonal contact. In this article, we review these recent data and suggest possible roles for the NGF and NGF receptor expressed on Schwann cells.

Destruction of sympathetic and sensory neurons in the developing rat by a monoclonal antibody against the nerve growth factor (NGF) receptor.

The ability of the monoclonal antibody, 192-IgG, directed against the rat nerve growth factor (NGF) receptor to mimic or inhibit the actions of NGF was examined in vitro and in vivo. 192-IgG had no effect on morphology, survival, or protein synthesis rates of sympathetic neuronal cultures. When injected into newborn rats, destruction of sympathetic, but not sensory, neurons was produced. Injection prenatally produced more dramatic destruction of sympathetic neurons and, in addition, destruction of neural crest-derived sensory neurons. Therefore, although 192-IgG had no discernible effects in vitro, it produced a pattern of neuronal destruction in vivo qualitatively similar to that produced by antibodies to NGF itself.

Diabetic patients treated with abciximab and intracoronary stenting

Diabetic patients are at greater risk for restenosis, recurrent ischemia, and complications following angioplasty than are their nondiabetic counterparts. This is a retrospective study identifying diabetic patients who were treated with abciximab and intracoronary stenting during the period of January 1997 to December 1999. Abciximab was administered to 268 of 707 diabetic patients who received intracoronary stents from 1997 to 1999. The abciximab group contained a higher number of patients with severe ventricular dysfunction and high‐grade lesions. Primary endpoints of all‐cause mortality, same‐vessel revascularization, CABG, TVR, and postprocedural myocardial infarction were similar for both groups. The abciximab group had reduced rates of readmission for cardiac reasons during all follow‐up periods. The trends toward improvement of mortality, surgical or percutaneous revascularization, and cardiac readmissions suggest the effect of abciximab may provide benefit for up to 9 months for higher‐risk diabetic patients. Cathet Cardiovasc Intervent 2002;55:321–325.