If go to the ER/ your faimily doctor/cardiologist with a Chest pain and the physician thinks that you have some thing called unstable coronary syndrome and has apropriate TIMI score,getting a loading dose of Plavix and apropriate dose of crestor is a very good standared of care, on top of other meds and interventions. The 600 mg plavix is only one time dose,after that you will get a much lower dose on a daily basis, the reason for giving the crestor is for some thing called its "pleotropic effects "in addition to the cholesterol lowering effects. You got the right treatment.

CURRENT-OASIS 7- trial results published in the New England Journal of Medicine (NEJM) and the Lancet.
The results, showing no significant benefit of doubling the dose of clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi-Aventis) for the first seven days in the overall population of ACS patients referred for an invasive strategy but suggesting benefit in the patients who actually underwent PCI, were first presented at the European Society of Cardiology (ESC) 2009 Congress.

The CURRENT-OASIS 7 authors, led by Dr Shamir Mehta (McMaster University, Hamilton, ON), say they still find the argument for use of the double-dose clopidogrel in patients undergoing PCI "compelling." The reasons they give for this include the fact that the benefit is biologically plausible and is consistent with several previous smaller studies.

In the NEJM editorial, Dr Valentin Fuster (Mount Sinai School of Medicine, New York) says that he has already adopted this practice on the basis of available data and latest guidelines. He suggests that the 600-mg loading dose without the subsequent higher doses in the next six days may be the best way forward.

In the Lancet editorial, Dr Greg Stone (Columbia University Medical Center, New York) observes that despite impressive reductions in MI and stent thrombosis with double-dose clopidogrel in patients who had PCI, the 30-day rates of cardiovascular death were identical in the standard-dose and double-dose clopidogrel groups. "Presumably, any benefits from reduced ischemic complications in reducing mortality were offset by increased rates of major bleeding with double-dose clopidogrel," he suggests.

The CURRENT-OASIS 7 authors address how these results might be incorporated into clinical practice when it is not known whether a patient will ultimately receive a PCI at the time of presentation. They note that in individuals who did not receive PCI, no apparent increase was recorded in the risk of bleeding with the high-dose clopidogrel regimen, and most major bleeding events occurred after PCI rather than before PCI. Therefore, a 600-mg loading dose could be considered for all patients with ACS with planned early invasive treatment. After coronary angiography, patients receiving a PCI could continue with the double maintenance dose to complete the full-seven day regimen, whereas in those who do not have anatomy suitable for PCI, the standard dose could be used or clopidogrel could be withheld, depending on the clinical context, they suggest.

They point out that guideline committees already recommend a 600-mg loading dose of clopidogrel on the basis of previous studies, and many centers are using this higher loading dose in daily practice. In individuals who have planned conservative treatment or in whom invasive assessment might be delayed beyond 72 hours, the standard dose of clopidogrel should still be used on the basis of data from previous studies, they add.

Bhatt said there were a few ways to interpret the data, "but my practical interpretation is that if you are planning to stent an ACS patient, you ought to give the double dose of clopidogrel for the first week. This should reduce stent thrombosis by almost 50%, as well as increase bleeding, though not fatal or intracranial bleeding." He added: "If you are planning to medically manage the patient initially, you should stick with standard clopidogrel dosing."

Ultimately the decision should be made on a patient to patient basis weighing the benefit vs the risks.

Please follow the following links for more information:

High-dose clopidogrel given in the cath lab equivalent to preloading
[Interventional/Surgery > Interventional/Surgery; Aug 06, 2010]
ARMYDA-4 RELOAD published: Should clopidogrel be reloaded for PCI in patients taking chronic therapy?
[Interventional/Surgery > Interventional/Surgery; Apr 21, 2010]
PLATO-Invasive in print, with new data on stent thrombosis for ticagrelor
[Interventional/Surgery > Interventional/Surgery; Jan 13, 2010]
HORIZONS analysis: 600-mg clopidogrel load preferable in primary PCI
[Acute Coronary Syndromes > Acute coronary syndromes; Oct 01, 2009]
Doubling dose of clopidogrel benefits STEMI patients without risk of bleeding
[Interventional/Surgery > Interventional/Surgery; Sep 24, 2009]
CURRENT OASIS-7: Benefit to doubling clopidogrel dose in ACS patients undergoing PCI
[Acute Coronary Syndromes > Acute coronary syndromes; Aug 30, 2009]
Tailoring clopidogrel loading on the basis of responsiveness testing reduces stent thrombosis
[Thrombosis > Thrombosis risk; Nov 10, 2008]