Several investigations have explored various loading doses of clopidogrel before or during PCI. Compared with a 300-mg loading dose, doses of either 600 mg or 900 mg achieve greater degrees of platelet inhibition with fewer low responders.577 A meta-analysis of 7 studies that included 25,383 patients undergoing PCI demonstrated that intensified loading of clopidogrel with 600 mg reduces the rate of MACE without an increase in major bleeding compared with 300 mg.578 Another study suggested that a 600-mg loading dose of clopidogrel is associated with improvements in procedural angiographic endpoints and 1-year clinical out- comes in patients with STEMI who undergo primary PCI compared with a 300-mg dose.579 There is no benefit with increasing the loading dose to 900 mg compared with 600 mg.577 Clopidogrel 75 mg daily should be given for a minimum of 4 weeks after balloon angioplasty or BMS Levine et al 2011 ACCF/AHA/SCAI PCI Guideline e605 implantation (a minimum of 2 weeks if increased bleeding risk is present)580 and for at least 12 months after DES implantation (unless the risk of bleeding outweighs the anticipated benefit). Patients should be counseled on the need for and risks of DAPT before stent implantation, especially DES implantation, and alternative therapies pursued (BMS or balloon angioplasty) if they are unwilling or unable to comply with the recommended duration of DAPT. The efficacy of clopidogrel pretreatment remains contro- versial. 