What about Clopidogrel (Plavix)?

From the Guidelines

Clopidogrel (Plavix) is recommended as an antiplatelet therapy for patients with unstable angina or non-ST-elevation myocardial infarction, with a loading dose of 300 mg and a maintenance dose of 75 mg daily, due to its efficacy in reducing platelet aggregation and ischemic events, as supported by the 2011 ACCF/AHA guidelines 1. The choice of Clopidogrel is based on its pharmacology, which involves a prodrug that requires conversion to an active metabolite to irreversibly block the P2Y12 receptor, leading to a delay of several hours before maximal antiplatelet effect is seen. Some key considerations for Clopidogrel use include:

• A higher variability of response compared to other antiplatelet agents, such as Prasugrel, which may be influenced by genetic predisposition and drug interactions, such as with proton pump inhibitors (PPIs) 1.
• The clinical utility of platelet function testing and genotyping is not rigorously established, but may be useful in selected patients with ischemic or thrombotic events while on Clopidogrel 1.
• The risk of bleeding with standard dosing of Clopidogrel is generally lower compared to Prasugrel, but higher doses of Clopidogrel may increase the risk of bleeding 1.
• When transitioning to elective or nonurgent surgery, it is recommended to wait at least 5 days after the last dose of Clopidogrel 1.

From the FDA Drug Label

Clopidogrel tablets are a prescription medicine used to treat people who have any of the following: chest pain due to heart problems poor circulation in their legs (peripheral arterial disease) a heart attack a stroke Clopidogrel tablets are used alone or with aspirin to lower your chance of having another serious problem with your heart or blood vessels such as heart attack, stroke, or blood clot that can lead to death.

Clopidogrel (Plavix) is a blood thinner medicine that lowers the chance of blood clots forming in the body. It is used to treat conditions such as:

• Chest pain due to heart problems
• Poor circulation in the legs (peripheral arterial disease)
• Heart attack
• Stroke It is used alone or with aspirin to lower the chance of having another serious problem with the heart or blood vessels. 2 2 2

From the Research

Overview of Clopidogrel (Plavix)

• Clopidogrel is a selective inhibitor of ADP-induced platelet aggregation, used to reduce the risk of subsequent vascular ischemic events in patients with symptomatic atherosclerosis 3, 4, 5.
• It has been shown to be more effective than aspirin in reducing the risk of ischemic stroke, myocardial infarction, or vascular death in patients with a broad spectrum of symptomatic atherosclerosis 3, 5.

Clinical Trials and Studies

• The CAPRIE study, a randomized, blinded, active control trial, demonstrated that clopidogrel reduced the combined risk of ischemic stroke, myocardial infarction, or vascular death by 8.7% compared with aspirin 3, 5.
• Another study found that treatment with clopidogrel in addition to standard therapy, including aspirin, significantly reduced the risk of cardiovascular death, myocardial infarction, or stroke in patients with acute coronary syndromes 4.
• A review of clinical trials and registries found that a 300-mg loading dose of clopidogrel was beneficial in reducing the risk of major adverse cardiovascular events in patients with acute coronary syndromes 6.

Dosage and Administration

• The recommended dose of clopidogrel is 75 mg once daily, with a loading dose of 300 mg in some cases 3, 6.
• The drug can be administered with or without food, and no dose adjustment is necessary in patients with renal impairment or mild-to-moderate hepatic impairment 3.
• A novel regimen of alternate-day clopidogrel has been proposed as a cost-effective strategy to prevent very late stent thrombosis 7.

Safety and Tolerability

• Clopidogrel has been shown to have a favorable risk/benefit ratio, with a low incidence of severe side effects 3, 5.
• The most common side effects of clopidogrel include diarrhea, rash, and pruritus, while gastrointestinal hemorrhage is less common than with aspirin 3, 5.
• The use of clopidogrel with other medications, such as heparin, warfarin, or non-steroidal anti-inflammatory drugs, should be done with caution due to the potential for increased bleeding risk 3, 4.