What is clopidogrel (Plavix)?

From the Guidelines

Clopidogrel is a prescription antiplatelet medication that prevents blood clots by stopping platelets from sticking together, primarily used to prevent heart attacks and strokes in people with cardiovascular disease. It belongs to a class of drugs called P2Y12 inhibitors and is commonly sold under the brand name Plavix. Clopidogrel is typically prescribed at a dose of 75 mg once daily for maintenance therapy, though a 300-600 mg loading dose may be given when rapid effect is needed, as seen in the study by 1. The medication works by irreversibly binding to the P2Y12 receptor on platelets, preventing them from aggregating and forming clots. Some key points to consider when prescribing clopidogrel include:

• The optimum loading dose of clopidogrel has not been established, but higher oral loading doses such as 600 mg may more rapidly inhibit platelet aggregation, as noted in the study by 1.
• Patients taking clopidogrel should be aware that it increases bleeding risk, so they should inform healthcare providers before any surgical procedures.
• It's also important to take clopidogrel consistently as prescribed, as suddenly stopping can increase risk of cardiovascular events.
• Some patients may be poor metabolizers of clopidogrel due to genetic variations, potentially requiring alternative antiplatelet therapy, as mentioned in the study by 1. The clinical benefit of dual antiplatelet therapy with clopidogrel and aspirin has been confirmed in patients undergoing PCI and in those presenting with an acute ST-segment elevation MI, as seen in the study by 1. However, the same strategy was not proven successful when compared with aspirin alone in stable patients at high risk for atherothrombotic events or with clopidogrel alone in patients after a recent ischemic stroke or TIA. Overall, clopidogrel is an effective medication for preventing heart attacks and strokes in people with cardiovascular disease, but it should be used with caution and under the guidance of a healthcare provider, as noted in the studies by 1 and 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. Platelets are blood cells that help your blood clot normally. Clopidogrel tablets help to prevent platelets from sticking together and forming a clot that can block an artery.

Clopidogrel is a prescription medicine that helps prevent platelets from sticking together and forming a clot that can block an artery. It is used to treat people with:

• Chest pain due to heart problems
• Poor circulation in their 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, such as heart attack, stroke, or blood clot that can lead to death 2.

From the Research

Definition and Mechanism of Clopidogrel

• Clopidogrel, also known as Plavix or Iscover, is an antiplatelet medication that selectively and irreversibly inhibits adenosine diphosphate (ADP)-induced platelet aggregation 3.
• It is used to prevent thrombosis in patients with established cardiovascular disease.

Clinical Uses of Clopidogrel

• Clopidogrel is used for the secondary prevention of ischemic events in patients with various cardiovascular conditions, including those with ischemic stroke or acute coronary syndromes 3.
• It is also used in patients with symptomatic peripheral artery disease (PAD) as a monotherapy, which has been shown to significantly reduce the risk of major adverse cardiovascular events compared to aspirin 4.
• In patients with minor ischemic stroke or high-risk transient ischemic attack (TIA), combination therapy with clopidogrel and aspirin has been shown to reduce the risk of major ischemic events, but increases the risk of major hemorrhage 5.

Efficacy and Safety of Clopidogrel

• Studies have shown that clopidogrel is more effective than aspirin in reducing the risk of recurrent stroke, but increases the risk of major bleeding events 6.
• A systematic review and meta-analysis found that clopidogrel monotherapy is associated with a lower risk of major adverse cardiovascular and cerebrovascular events, recurrent stroke, and bleeding events compared to aspirin monotherapy in patients with recent ischemic stroke 7.
• The efficacy and safety of clopidogrel have been established in several large randomized trials, including the CAPRIE, CURE, COMMIT, and CLARITY-TIMI 28 trials 3.