What is Deplatt tablet (clopidogrel)?

What is Deplatt Tablet?

Deplatt is a brand name for clopidogrel, a prescription antiplatelet medication that prevents blood clots by irreversibly blocking platelet ADP receptors, thereby reducing the risk of heart attack, stroke, and vascular death in patients with atherosclerotic disease.

Mechanism of Action

• Clopidogrel is a prodrug that must be metabolized by the liver to its active form, which then irreversibly inhibits the P2Y12 receptor on platelets, preventing ADP-mediated platelet aggregation 1, 2
• The antiplatelet effect is slow in onset (taking several hours to days to reach full effect) and irreversible for the lifespan of the platelet (approximately 7-10 days) 3
• Clopidogrel achieves approximately 35-44% inhibition of ADP-induced platelet aggregation at the standard 75 mg daily dose 4

FDA-Approved Indications

Clopidogrel is indicated for:

• Recent myocardial infarction (heart attack) - to reduce the risk of subsequent cardiovascular events 1, 2
• Recent ischemic stroke - for secondary prevention of recurrent stroke 1, 5
• Peripheral arterial disease - to reduce cardiovascular complications 1, 5
• Acute coronary syndrome (ACS) - both ST-elevation and non-ST-elevation MI, typically in combination with aspirin 5
• After coronary stent placement - to prevent in-stent thrombosis 3, 5

Standard Dosing

The evidence-based dosing regimen is:

• Maintenance dose: 75 mg once daily - this is the standard dose for all approved indications 5, 4
• Loading dose: 300-600 mg - used in acute settings (ACS, stroke) to achieve more rapid platelet inhibition 5
• Duration: Minimum 12 months after ACS or stent placement, followed by consideration of long-term monotherapy 5

Clinical Efficacy Compared to Aspirin

• In the landmark CAPRIE trial of 19,185 patients with atherosclerotic disease, clopidogrel 75 mg daily reduced the combined risk of ischemic stroke, MI, or vascular death by 8.7% compared to aspirin 325 mg daily (5.3% vs 5.8%, p=0.04) 5, 2
• Clopidogrel is recommended as a safe and effective alternative to aspirin for patients who cannot tolerate aspirin or have contraindications 5
• When used alone, clopidogrel causes less severe bleeding and less intracranial hemorrhage compared to aspirin 6

Dual Antiplatelet Therapy (DAPT)

Clopidogrel is commonly combined with aspirin in high-risk situations:

• For acute coronary syndrome: Clopidogrel 75 mg + aspirin 75-100 mg daily for 12 months is the standard regimen when ticagrelor or prasugrel cannot be used 5
• For minor stroke/high-risk TIA: Clopidogrel 75 mg + aspirin 81 mg daily for 21 days, then switch to monotherapy 5
• The combination shows synergistic inhibitory effects on platelet aggregation, particularly after stimulation with collagen and thrombin 7
• However, DAPT significantly increases bleeding risk (3.7% vs 2.7% major bleeding) compared to monotherapy 5

Important Safety Considerations

Critical warnings that patients and providers must understand:

• Bleeding risk: Clopidogrel increases bruising, bleeding time, and risk of serious hemorrhage including gastrointestinal and intracranial bleeding 1, 6
• Do not stop abruptly: Premature discontinuation significantly increases risk of stent thrombosis, heart attack, stroke, and death 1
• Genetic variability: Approximately 2-14% of patients are "poor metabolizers" due to CYP2C19 genetic polymorphisms, resulting in reduced drug effectiveness 1
• Drug interactions: Avoid concomitant use with omeprazole or esomeprazole, as these proton pump inhibitors significantly reduce clopidogrel's antiplatelet activity 1
• Thrombotic thrombocytopenic purpura (TTP): Rare but life-threatening complication, usually occurring within 2 weeks of initiation, requiring immediate plasma exchange 5, 1

Contraindications

Clopidogrel should NOT be used in patients with:

• Active pathological bleeding (peptic ulcer, intracranial hemorrhage) 1
• Known hypersensitivity to clopidogrel 1
• Severe hepatic impairment 2

Perioperative Management

• Continue aspirin perioperatively if bleeding risk allows, but clopidogrel should typically be discontinued 5-7 days before elective surgery to allow platelet function recovery 5
• Do not discontinue DAPT within the first month after stent placement for elective non-cardiac surgery due to prohibitive risk of stent thrombosis 5
• For urgent surgery, the irreversible platelet inhibition means increased bleeding risk that can only be mitigated with platelet transfusion 3

Practical Administration Details

• Can be taken with or without food 2
• No dose adjustment needed based on age, gender, weight, race, or mild-to-moderate renal impairment 2
• No routine hematological monitoring required (unlike ticlopidine) 5, 2
• A proton pump inhibitor should be prescribed concurrently in patients at increased gastrointestinal bleeding risk, but avoid omeprazole/esomeprazole; use pantoprazole, lansoprazole, or dexlansoprazole instead 5, 1

When Clopidogrel is Preferred Over Newer Agents

Clopidogrel remains the P2Y12 inhibitor of choice in specific situations:

• Patients requiring oral anticoagulation (triple therapy) - clopidogrel has significantly lower bleeding risk than ticagrelor or prasugrel 5, 8
• Patients with prior intracranial hemorrhage - ticagrelor and prasugrel are contraindicated 5
• Patients with prior ischemic stroke/TIA - prasugrel is contraindicated 5
• Stable coronary artery disease after initial DAPT period - clopidogrel 75 mg daily is as effective as aspirin for long-term secondary prevention 5
• Resource-limited settings - clopidogrel is significantly less expensive than ticagrelor or prasugrel 5