Benefits and risks of clopidogrel use in patients with coronary artery disease: Evidence from randomized studies and registries
Abstrakt
Background: Aggressive antiplatelet treatment is currently an established practice in patients with coronary artery disease. Objective: This article discusses the evidence from clinical trials and registries concerning the benefits and risks of clopidogrel in relation to the dose and timing of treatment and its use in particular patient populations (stratified by risk factors for major adverse cardiovascular events).
Methods: Human clinical trials, registries, and in vitro human platelet studies were identified through searches of MEDLINE, Scopus, Google Scholar, and ClinicalTrials.gov (January 1980-July 2008) using the terms clopidogrel in coronary artery disease, clopidogrel loading dose, clopidogrel pretreatment, and antiplatelet therapy for coronary artery disease. For inclusion in the review, publications had to compare clopidogrel administered at different doses and times across the spectrum of patients with coronary artery disease; present outcome data on mortality, reinfarction, stroke, or their combination; and report safety data pertaining to bleeding risk.
Conclusions: Suppression of platelet activity through the use of antithrombotic agents should be balanced against the risk of atherothrombotic events. In patients with ACS, inhibition of platelet activation beyond that produced by clopidogrel 600 mg has been associated with an increased bleeding risk.
In patients undergoing elective PCI, pretreatment with clopidogrel 300 mg administered > 15 hours before the procedure achieved the optimal risk-benefit ratio. In cases of unplanned PCI, administration of clopidogrel 600 mg immediately after diagnostic catheterization was well tolerated and effective