ALBION "Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis"

Inclusion criteria

• Patient hospitalised with ischemic symptoms (onset < 48 hours) and at least one of the following characteristics of NSTEMI:

• ECG ST or T changes
• positive troponin
• Patient treated on admission with 250-500 mg aspirin (oral or IV) and who will receive low dose aspirin (< or = 100 mg daily) from the next day on
• Patient treated with bid LMWH (indicated dosage for this indication)

Exclusion criteria

• Catheterization scheduled within 24 hours after randomisation
• Patient presenting an absolute contra-indication to the use of clopidogrel and/or ASA:

• history of drug allergy to thienopyridine derivatives or ASA
• Severe uncontrolled hypertension (BP > 180 / 100 despite therapy)
• Platelet count < 100 000 / mm3
• Neutrophil count < 1800 / mm3
• Patient with increased risk of bleeding, such as severe hepatic insufficiency, current peptic ulceration, proliferative diabetic retinopathy
• History of severe systemic bleeding
• Patient with any contraindication to LMWH
• Patient treated with clopidogrel within the last 10 days
• Patient treated with oral anticoagulants or hirudin or planned to receive these products during the hospitalisation period
• Patient treated with ticlopidine, dipyridamol, NSAIDs (including Cox1 and Cox2 inhibitors), cilostazol, GPIIb IIIa antagonists or planned to receive any of these products within the next 24 hours following randomisation.
• Patient whose arm venous status is incompatible with an indwelling catheter
• Patient presenting an evolving cancer
• Patient with NYHA class IV heart failure
• Intubated and ventilated patient