From the Guidelines
Yes, Plavix (clopidogrel) should be given in the setting of acute ST-Elevation Myocardial Infarction (STEMI) as part of dual antiplatelet therapy (DAPT) alongside aspirin, with a recommended dose of 75 mg per day orally, and a loading dose of 300 mg for patients less than 75 years of age who receive fibrinolytic therapy or who do not receive reperfusion therapy 1.
Key Points
- The use of clopidogrel in STEMI patients is supported by the 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction 1.
- The COMMIT-CCS-2 study and the CLARITY-TIMI 28 study provide evidence for the benefit of clopidogrel in STEMI patients, with a reduction in the composite primary end point of death, reinfarction, or stroke 1.
- The 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation also recommend the use of DAPT, including clopidogrel, in STEMI patients 1.
Dosing and Administration
- The recommended dose of clopidogrel is 75 mg per day orally, with a loading dose of 300 mg for patients less than 75 years of age who receive fibrinolytic therapy or who do not receive reperfusion therapy 1.
- The choice between clopidogrel and other P2Y12 inhibitors, such as ticagrelor or prasugrel, should consider the patient's bleeding risk, comorbidities, and potential drug interactions 1.
Special Considerations
- Patients with high bleeding risk may require shorter DAPT duration, while those at high ischemic risk might benefit from extended therapy 1.
- Patients taking oral anticoagulants with renal insufficiency and/or the elderly represent a challenge in terms of optimal antithrombotic therapy, and special attention should be paid to dose adjustment of some pharmacological strategies in these subsets 1.
From the FDA Drug Label
Clopidogrel tablets are indicated to reduce the rate of myocardial infarction and stroke in patients with acute ST-elevation myocardial infarction (STEMI) who are to be managed medically.
In patients who need an antiplatelet effect within hours, initiate clopidogrel tablets with a single 300 mg oral loading dose and then continue at 75 mg once daily.
Yes, Plavix (clopidogrel) is given in the setting of acute ST-Elevation Myocardial Infarction (STEMI) to reduce the rate of myocardial infarction and stroke in patients who are to be managed medically, with a recommended initial loading dose of 300 mg orally, followed by 75 mg once daily. 2 2
From the Research
Use of Plavix (Clopidogrel) in Acute ST-Elevation Myocardial Infarction (STEMI)
- Plavix (clopidogrel) is used in the setting of acute coronary syndrome, including STEMI, as part of dual antiplatelet therapy (DAPT) with aspirin 3, 4, 5, 6.
- The optimal duration of DAPT with clopidogrel and aspirin in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI) is still a topic of debate, with some studies suggesting that short-term DAPT of 3-6 months may be equivalent to long-term DAPT in terms of efficacy and effectiveness 5.
- Clopidogrel is compared to other P2Y12 inhibitors such as prasugrel and ticagrelor in terms of efficacy and safety, with prasugrel and ticagrelor demonstrating greater efficacy than clopidogrel in some studies 6.
- The choice of antiplatelet therapy, including clopidogrel, should be individualized based on patient characteristics, bleeding risk, and clinical scenario 4, 5, 6.
Clinical Scenarios and Recommendations
- In patients with acute coronary syndrome undergoing PCI, DAPT with aspirin and clopidogrel for 12 months is a common strategy, although shorter or longer durations may be considered based on individual patient characteristics and clinical scenario 3, 5.
- For patients undergoing non-cardiac surgery after PCI, the management of DAPT is critical to balance the risk of stent thrombosis and bleeding complications, with recommendations varying based on the type of surgery, patient characteristics, and clinical scenario 4.
- The use of clopidogrel as part of DAPT in patients with stable ischemic heart disease is also being investigated, with some studies suggesting potential benefits of long-duration DAPT in this population 7.