Clopidogrel in ischemic heart disease: A critical appraisal

Mohammed A. Al-Otaiby, Abdulrahman M. Al-Moghairi

Adult Cardiology Department, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia.
Adult Cardiology Department, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia..

DOI: 10.4236/health.2013.53063                

Abstract

Aspirin and clopidogrel are the commonest dual antiplatelet agents being used in the secondary prevention of cardiovascular disease. In high risk patients with coronary heart disease, the use of aspirin was associated with a significant risk reduction of myocardial infarction, stroke and vascular death. The use of clopidogrel alone was slightly superior to aspirin, and associated with reduced risk of vascular death, ischemic stroke and myocardial infarction. Dual antiplatelet therapy has been well studied in patients with acute coronary syndrome and those undergoing percutaneous coronary intervention (PCI). In patients with stable coronary heart disease or multiple risk factors the combination of clopidogrel plus aspirin was not significantly more effective than aspirin alone in reducing MI, stroke or death from cardiovascular causes.

Keywords

Clopidogrel; Ischemic Heart Disease; Thienopyridine; Platelets Inhibition

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Herbert, J.M. and Savi, P. (2003) P2Y12, a new platelet ADP receptor, target of clopidogrel. Seminars in Vascular Medicine, 3, 113-122. doi:10.1055/s-2003-40669
[2]	Braunwald, E. et al. (2002) ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction—2002: Summary article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). Circulation, 106, 1893-1900. doi:10.1161/01.CIR.0000037106.76139.53
[3]	CAPRIE Steering Committee (1996) A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). Lancet, 348, 1329- 1239. doi:10.1016/S0140-6736(96)09457-3
[4]	Bhatt, D.L., et al. (2005) A global view of atherothrombosis: Baseline characteristics in the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial. American Heart Journal, 150, 401. doi:10.1016/j.ahj.2005.03.017
[5]	Bhatt, D.L., et al. (2007) Patients with prior myocardial infarction, stroke, or symptomatic peripheral arterial disease in the CHARISMA trial. Journal of the American College of Cardiology, 49, 1982-1988. doi:10.1016/j.jacc.2007.03.025
[6]	Sabatine, M.S., et al. (2005) Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. The New England Journal of Medicine, 352, 1179-1189. doi:10.1056/NEJMoa050522
[7]	Chen, Z.M., et al. (2005) Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: Randomised placebo-controlled trial. Lancet, 366, 1607-1621. doi:10.1016/S0140-6736(05)67660-X
[8]	Yusuf, S., et al. (2001) Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. The New England Journal of Medicine, 345, 494-502. doi:10.1056/NEJMoa010746
[9]	Elsasser, A., et al. (2005) Clopidogrel in acute coronary syndrome: When, how much, how long? Zeitschrift Fur Kardiologie, 94, 377-382. doi:10.1007/s00392-005-0224-3
[10]	Fox, K.A., et al. (2004) Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome: The Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (cure) trial. Circulation, 110, 1202-1208. doi:10.1161/01.CIR.0000140675.85342.1B
[11]	Khot, U.N. and Nissen, S.E. (2002) Is cure a cure for acute coronary syndromes? Statistical versus clinical significance. Journal of the American College of Cardiology, 40, 218-219. doi:10.1016/S0735-1097(02)01945-9
[12]	Mehta, S.R. (2003) Aspirin and clopidogrel in patients with ACS undergoing PCI: CURE and PCI-CURE. Journal of Invasive Cardiology, 15, 17B-20B, Discussion 20B-21B.
[13]	Steinhubl, S.R., et al. (2002) Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: A randomized controlled trial. The Journal of the American Medical Association, 288, 2411-2420. doi:10.1001/jama.288.19.2411
[14]	Holmes Jr., D.R., et al. (2010) ACCF/AHA clopidogrel clinical alert: Approaches to the FDA “boxed warning”: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the American Heart Association. Circulation, 122, 537- 557. doi:10.1161/CIR.0b013e3181ee08ed
[15]	Gurbel, P.A., et al. (2005) Platelet reactivity in patients and recurrent events poststenting: Results of the PRE-PARE POST-STENTING study. Journal of the American College of Cardiology, 46, 1820-1826. doi:10.1016/j.jacc.2005.07.041
[16]	Gurbel, P.A., et al. (2005) Clopidogrel effect on platelet reactivity in patients with stent thrombosis: Results of the CREST study. Journal of the American College of Cardiology, 46, 1827-1832. doi:10.1016/j.jacc.2005.07.056
[17]	Hochholzer, W., et al. (2006) Impact of the degree of peri-interventional platelet inhibition after loading with clopidogrel on early clinical outcome of elective coronary stent placement. Journal of the American College of Cardiology, 48, 1742-1750. doi:10.1016/j.jacc.2006.06.065
[18]	Bhatt, D.L., et al. (2006) Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. The New England Journal of Medicine, 354, 1706-1717. doi:10.1056/NEJMoa060989
[19]	Bhatt, D.L. (2007) Intensifying platelet inhibition—Navigating between Scylla and Charybdis. The New England Journal of Medicine, 357, 2078-2081. doi:10.1056/NEJMe0706859
[20]	Lanas, A., et al. (2006) Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut, 55, 1731-1738. doi:10.1136/gut.2005.080754
[21]	Lai, K.C., et al. (2006) Esomeprazole with aspirin versus clopidogrel for prevention of recurrent gastrointestinal ulcer complications. Clinical Gastroenterology and Hepatology, 4, 860-865. doi:10.1016/j.cgh.2006.04.019