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Medication Safety Issues
Sound-alike/look-alike issues:
Plavix® may be confused with Elavil®, Paxil®
Pronunciation
(kloh PID oh grel)
U.S. Brand Names
Index Terms
Generic Available
No
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use
Reduces rate of atherothrombotic events (myocardial infarction, stroke, vascular deaths) in patients with recent MI or stroke, or established peripheral arterial disease; reduces rate of atherothrombotic events in patients with unstable angina or non-ST-segment elevation acute coronary syndromes (unstable angina and non-ST-segment elevation MI) managed medically or through PCI (with or without stent) or CABG; reduces rate of death and atherothrombotic events in patients with ST-segment elevation MI (STEMI) managed medically
Use: Unlabeled/Investigational
In aspirin-allergic patients, prevention of coronary artery bypass graft closure (saphenous vein)
Pregnancy Risk Factor
B
Pregnancy Implications
Teratogenic effects were not observed in animal studies. Use during pregnancy only if clearly needed.
Lactation
Excretion in breast milk unknown/not recommended
Contraindications
Hypersensitivity to clopidogrel or any component of the formulation; active pathological bleeding such as PUD or intracranial hemorrhage; coagulation disorders
Warnings/Precautions
Concerns related to adverse effects:
• Thrombotic thrombocytopenic purpura (TTP): Cases of thrombotic thrombocytopenic purpura (usually occurring within the first 2 weeks of therapy), resulting in some fatalities, have been reported; urgent plasmapheresis is required.
Disease-related concerns:
• Bleeding disorders: Use with caution in patients with platelet disorders, bleeding disorders and/or at increased risk for bleeding (eg, peptic ulcer disease, trauma, or surgery).
• Hepatic impairment: Use with caution in patients with severe hepatic impairment (experience is limited).
• Renal impairment: Use with caution in patients with severe renal impairment (experience is limited).
Concurrent drug therapy issues:
• Platelet aggregation inhibitors: Use with caution in patients receiving other platelet aggregation inhibitors; bleeding risk is increased.
Special populations:
• Pediatrics: Safety and efficacy have not been established in children.
Other warnings/precautions:
• Coronary artery stents: In patients who have received bare-metal or drug-eluting stents (sirolimus or paclitaxel), interruption of antiplatelet therapy may result in stent thrombosis with subsequent fatal and nonfatal myocardial infarction. Ideally, 12 months following drug-eluting stent placement in patients not at high risk for bleeding is preferred; minimum durations of therapy are 1 month, 3 months, and 6 months for bare metal, sirolimus (Cypher®), and paclitaxel (Taxus®), respectively.
• Elective surgery: Consider discontinuing 5 days before elective surgery (except in patients with cardiac stents that have not completed their full course of dual antiplatelet therapy; patient-specific situations need to be discussed with cardiologist; AHA/ACC/SCAI/ACS/ADA Science Advisory provides recommendations).
Adverse Reactions
As with all drugs which may affect hemostasis, bleeding is associated with clopidogrel. Hemorrhage may occur at virtually any site. Risk is dependent on multiple variables, including the concurrent use of multiple agents which alter hemostasis and patient susceptibility.
>10%: Gastrointestinal: The overall incidence of gastrointestinal events (including abdominal pain, vomiting, dyspepsia, gastritis, and constipation) has been documented to be 27% compared to 30% in patients receiving aspirin.
3% to 10%:
Cardiovascular: Chest pain (8%), edema (4%), hypertension (4%)
Central nervous system: Headache (3% to 8%), dizziness (2% to 6%), depression (4%), fatigue (3%), general pain (6%)
Dermatologic: Rash (4%), pruritus (3%)
Endocrine & metabolic: Hypercholesterolemia (4%)
Gastrointestinal: Abdominal pain (2% to 6%), dyspepsia (2% to 5%), diarrhea (2% to 5%), nausea (3%)
Genitourinary: Urinary tract infection (3%)
Hematologic: Bleeding (major 4%; minor 5%), purpura (5%), epistaxis (3%)
Hepatic: Liver function test abnormalities (<3%; discontinued in 0.11%)
Neuromuscular & skeletal: Arthralgia (6%), back pain (6%)
Respiratory: Dyspnea (5%), rhinitis (4%), bronchitis (4%), cough (3%), upper respiratory infection (9%)
Miscellaneous: Flu-like syndrome (8%)
1% to 3%:
Cardiovascular: Atrial fibrillation, cardiac failure, palpitation, syncope
Central nervous system: Fever, insomnia, vertigo, anxiety
Dermatologic: Eczema
Endocrine & metabolic: Gout, hyperuricemia
Gastrointestinal: Constipation, GI hemorrhage, vomiting
Genitourinary: Cystitis
Hematologic: Hematoma, anemia
Neuromuscular & skeletal: Arthritis, leg cramps, neuralgia, paresthesia, weakness
Ocular: Cataract, conjunctivitis
<1% (Limited to important or life-threatening): Agranulocytosis, allergic reaction, anaphylactoid reaction, bilirubinemia, bronchospasm, bullous eruption, fatty liver, granulocytopenia, hematuria, hemoptysis, hemorrhagic stroke (0.1%), hemothorax, hypochromic anemia, intracranial hemorrhage (0.4%), ischemic necrosis, leukopenia, maculopapular rash, menorrhagia, neutropenia (0.05%), ocular hemorrhage, paresthesia, pulmonary hemorrhage, purpura, retroperitoneal bleeding, thrombocytopenia, urticaria
Postmarketing and/or case reports: Acute liver failure, aplastic anemia, angioedema, confusion, erythema multiforme, hallucination, hepatitis, hypersensitivity, interstitial pneumonitis, lichen planus, pancreatitis, pancytopenia, serum sickness, Stevens-Johnson syndrome, stomatitis, taste disorder, thrombotic thrombocytic purpura (TTP), toxic epidermal necrolysis, vasculitis
Drug Interactions
Substrate (minor) of CYP1A2, 3A4; Inhibits CYP2C9 (weak)
Anticoagulants: May increase the risk of bleeding. Anticoagulant interacting members include antithrombin III, argatroban, bivalirudin, dalteparin, danaparoid, drotrecogin alfa, enoxaparin, fondaparinux, heparin, hirudin, lepirudin, nadroparin, tinzaparin, and warfarin. Use with heparin or low-molecular-weight heparin in acute coronary syndrome is clinically accepted.
Antiplatelet agents: May enhance the anticoagulant effect of other antiplatelet agents. Antiplatelet agent interacting members include abciximab, anagrelide, cilostazol, dipyridamole, eptifibatide, ticlopidine, and tirofiban.
Atorvastatin: Atorvastatin may attenuate the effects of clopidogrel; monitor.
Drotrecogin alfa: May increase the risk of bleeding.
Macrolide antibiotics: CYP3A4-inhibiting macrolides may attenuate the effects of clopidogrel. These include clarithromycin, erythromycin, and troleandomycin. Monitor.
NSAIDs: Concurrent use with clopidogrel may increase gastrointestinal effects, including GI blood loss. NSAID use was excluded in ACS trial (CURE).
Rifampin: Rifampin may increase the effects of clopidogrel; monitor.
Salicylates: Antiplatelet agents may enhance the adverse/toxic effect of salicylates; increased risk of bleeding may result. Though combined therapy is at times used advantageously, an increased risk of bleeding must be acknowledged and managed.
Thrombolytics: May increase the risk of bleeding.
Treprostinil: May enhance the adverse/toxic effect of antiplatelet agents. Bleeding may occur.
Ethanol/Nutrition/Herb Interactions
Herb/Nutraceutical: Avoid alfalfa, anise, bilberry, bladderwrack, bromelain, cat's claw, chamomile, coleus, cordyceps, dong quai, evening primrose oil, fenugreek, feverfew, garlic, ginger, ginkgo biloba, ginseng (American), ginseng (Panax), ginseng (Siberian), grape seed, green tea, guggul, horse chestnut seed, horseradish, licorice, prickly ash, red clover, reishi, SAMe (S-adenosylmethionine), sweet clover, turmeric, white willow (all have additional antiplatelet activity).
Storage
Store at 25°C (77°F); excursions permitted to 15°C to 3°C (59°F to 86°F).
Mechanism of Action
Clopidogrel requires in vivo biotransformation to an unidentified active metabolite. This active metabolite irreversibly blocks the P2Y12 component of ADP receptors, which prevents activation of the GPIIb/IIIa receptor complex, thereby reducing platelet aggregation. Platelets blocked by clopidogrel are affected for the remainder of their lifespan.
Pharmacodynamics/Kinetics
Onset of action: Inhibition of platelet aggregation detected: 2 hours after 300 mg administered; after second day of treatment with 50-100 mg/day. At steady-state with 75 mg/day, the average inhibition level observed was 40% to 60%.
Peak effect: 50-100 mg/day: Bleeding time: 5-6 days; Platelet function: 3-7 days
Absorption: Well absorbed
Protein binding: Parent drug: 98%; metabolite: 94%
Metabolism: Extensively hepatic via hydrolysis; biotransformation primarily to carboxyl acid derivative (inactive). The active metabolite that inhibits platelet aggregation has not been isolated.
Half-life elimination: ?8 hours
Time to peak, serum: ?1 hour
Excretion: Urine (50%); feces (46%)
Dosage
Oral: Adults:
Recent MI, recent stroke, or established arterial disease: 75 mg once daily
Acute coronary syndrome:
Unstable angina, non-ST-segment elevation myocardial infarction (UA/NSTEMI): Initial: 300 mg loading dose, followed by 75 mg once daily (in combination with aspirin 75-325 mg once daily). Note: A loading dose of 600 mg has been used in some investigations; limited research exists comparing the two doses.
ST-segment elevation myocardial infarction (STEMI): 75 mg once daily (in combination with aspirin 75-162 mg/day). CLARITY used a 300 mg loading dose of clopidogrel (with thrombolysis). The duration of therapy was <28 days (usually until hospital discharge).
Note: Drug-eluting stents: Duration of clopidogrel (in combination with aspirin): Ideally 12 months following drug-eluting stent placement in patients not at high risk for bleeding; at a minimum, 1, 3, and 6 months for bare metal, sirolimus, and paclitaxel stents, respectively, for uninterrupted therapy. Interruption of therapy may result in stent thrombosis with subsequent fatal and nonfatal myocardial infarction.
Prevention of coronary artery bypass graft closure (saphenous vein) [Chest guidelines, 2004]: Aspirin-allergic patients (unlabeled use): Loading dose: 300 mg 6 hours following procedure; maintenance: 75 mg/day
Dosing adjustment in renal impairment and elderly: None necessary
Monitoring Parameters
Signs of bleeding; hemoglobin and hematocrit periodically
Dietary Considerations
May be taken without regard to meals.
Patient Education
Take as directed. May cause headache or dizziness; use caution when driving or engaging in tasks that require alertness until response to drug is known. It may take longer than usual to stop bleeding. Small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may reduce nausea or vomiting. Mild analgesics may reduce arthralgia or back pain. Inform prescribers and dentists that you are taking this medication prior to scheduling any surgery or dental procedure. Report immediately unusual or acute chest pain or respiratory difficulties; skin rash; unresolved bleeding, diarrhea, or GI distress; nosebleed; or acute headache. Breast-feeding precaution: Breast-feeding is not recommended.
Geriatric Considerations
Plasma concentrations of the main metabolite of clopidogrel were significantly higher in the elderly (?75 years). This was not associated with changes in bleeding time or platelet aggregation. No dosage adjustment is recommended.
Anesthesia and Critical Care Concerns/Other Considerations
Withhold clopidogrel for 5-7 days prior to elective CABG surgery.
Cardiovascular Considerations
Acute Coronary Syndrome (ACS): The 2007 ACC/AHA guidelines for unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI) recommend administration of clopidogrel to hospitalized patients who are unable to take aspirin because of hypersensitivity or major gastrointestinal intolerance (Class I; level of evidence: A). In certain situations, patients may even be desensitized to aspirin so that they may receive aspirin and clopidogrel concurrently. The CURE trial demonstrated that clopidogrel reduced major cardiovascular events in patients with ACS without ST-segment elevation (Yusuf S, 2001). In this trial, the risk of major bleeding was significantly increased in the clopidogrel group although life-threatening bleeding and hemorrhagic strokes were similar in both groups. In hospitalized UA/NSTEMI patients in whom an early noninvasive strategy is planned, clopidogrel should be added to aspirin and anticoagulant therapy as soon as possible (Class I, Level of evidence A).
In UA/NSTEMI patients in whom an invasive strategy will be employed, antiplatelet therapy should be initiated prior to diagnostic angiography. This can be done with either clopidogrel or a glycoprotein IIb/IIIa inhibitor (eg, eptifibatide) (Class I, Level of evidence A). The PCI-CURE trial, a substudy of the CURE trial, suggested that in patients with ACS undergoing percutaneous coronary intervention (PCI) receiving aspirin, a strategy of clopidogrel pretreatment followed by long-term therapy (9 months) is beneficial in reducing major cardiovascular events, compared with placebo (Mehta SR, 2001). In the CREDO trial, long-term (1 year) clopidogrel treatment (75 mg daily) following PCI, significantly reduced the risk of adverse ischemic events (Steinhubl SR, 2002). In CREDO, the issue of timing was evaluated and a 300 mg loading dose of clopidogrel must be given at least 6 hours before PCI. More recently, however, a 600 mg loading dose of clopidogrel was shown to result in maximal platelet inhibition at 2 hours (Hochholzer W, 2005).
In patients taking clopidogrel in whom elective CABG is planned, clopidogrel should be withheld for 5-7 days before elective CABG. If urgent CABG is required, the benefits of surgery should outweigh the risks of incremental bleeding.
ST-Segment Elevation Myocardial Infarction (STEMI): The COMMIT trial (Chen ZM, 2005), randomized 45,852 patients with an acute MI (supporting ECG abnormalities), presenting within 24 hours of onset of symptoms, to clopidogrel 75 mg daily or placebo. All patients received aspirin and standard medical care (eg, thrombolytics if appropriate, ACEI). Clopidogrel was continued for 28 days or until hospital discharge whichever came first. The primary outcome measure was a composite of death, MI, or stroke. Patients in the clopidogrel arm had a significantly lower death rate (7.5% clopidogrel, 8.1% placebo; p=0.002).The CLARITY trial (Scirica BM, 2006) evaluated clopidogrel in the setting of thrombolysis and its relationship to ST-segment resolution. The randomized, double blind, placebo controlled trial included 3491 patients within 12 hours of the onset of STEMI who were candidates for thrombolytic therapy. Patients were randomized to receive clopidogrel (300 mg loading dose, then 75 mg daily) or placebo until angioplasty, discharge, or Day 8. Patients also received aspirin (loading dose followed by 75-162 mg/day). The ECG was monitored at baseline, and 90- and 180 minutes after thrombolysis. There was no difference in ECG resolution (none, partial, complete) between the groups at 90 minutes. Patients with partial (30% to 70%) and complete (>70%) ST-segment resolution on clopidogrel had significantly improved patency on discharge angiogram over placebo patients with similar ST-segment resolution. The clopidogrel group with partial ST segment resolution had a significantly lower rate of in-hospital death and MI than their placebo counterparts. The clopidogrel group with complete resolution of ST-segments showed a trend toward a reduction of in-hospital death and MI but it was not statistically significant (p=0.056). Mortality was followed for 30 days; the clopidogrel group with complete resolution of ST-segment abnormalities had a significant reduction in the rate of death compared to its placebo counterpart.
Percutaneous Coronary Intervention (PCI): The 2004 ACC/AHA guidelines for ST-elevation myocardial infarction (STEMI) suggests that clopidogrel be continued for at least 1 month after bare-metal stent implantation, for several months after drug-eluting stent implantation (3 months for sirolimus, 6 months for paclitaxel), and ideally for up to 12 months in patients who are not at high risk for bleeding.
Coronary Artery Stents: The AHA/ACC/SCAI/ACS/ADA Science Advisory (2007) published recommendations (Circulation, February 13, 2007) to prevent premature discontinuation of dual antiplatelet therapy (clopidogrel, aspirin) in patients with coronary artery stents. This advisory panel agreed with the 2004 ACC/AHA guidelines stressing the importance of 12 months of dual antiplatelet therapy after placement of a drug-eluting stent (DES) in patients who are not at high risk of bleeding. The advisory panel included these recommendations. Minor surgery, teeth cleaning, and tooth extraction can usually be performed without increased bleeding on the dual antiplatelet regimen. If increased bleeding is anticipated, then the procedure should be delayed until the antiplatelet regimen is completed. Elective procedures with a significant risk of bleeding should be postponed until the antiplatelet regimen is completed. The Advisory panel recommends healthcare providers who perform invasive or surgical procedures contact the patient's cardiologist before discontinuing antiplatelet therapy. For patients with drug-eluting stents who must undergo a procedure that requires discontinuation of thienopyridine therapy, aspirin should be continued if possible and the thienopyridine restarted as soon as possible after the procedure. “Bridging” stent patients with warfarin, other antithrombins, or glycoprotein IIb/IIIa agents is not supported by the Advisory Committee.
For the complete review and additional recommendations available at: http://www.acc.org/qualityandscience/clinical/pdfs/Final_Dual_Antiplatelet_Statement_010507.pdf. Last accessed January 19, 2007.
High Cardiovascular-Event Risk Patients: The CHARISMA trial (Bhatt DL, 2006) evaluated the use of clopidogrel compared to placebo in 15,603 patients receiving low-dose aspirin (75-162 mg/day) who were at high risk of future cardiovascular events. This patient group included those with multiple atherothrombotic risk factors, documented coronary, cerebrovascular, or peripheral vascular disease. The primary outcome measure was a composite of myocardial infarction, stroke, or death from cardiovascular causes. The primary outcome measure occurred in 6.8% of patients receiving clopidogrel and aspirin vs. 7.3% with placebo and aspirin (p=0.22). The rates of the secondary endpoints which included hospitalizations for ischemic events, was 16.7% and 17.9% (p=0.04). The rate of GUSTO-defined severe bleeding was 1.7% and 1.3% (p=0.09). A prespecified subgroup analysis divided patients into a “symptomatic” group (with documented cardiovascular disease) and an “asymptomatic” group (without documented cardiovascular disease). In the patients considered symptomatic, the primary event rate was lower in the clopidogrel group compared to placebo (6.9% vs 7.9%, p=0.046). In patients considered asymptomatic, there was a 20% relative increase in the primary event rate (6.6% vs 5.5%; p=0.20) if receiving clopidogrel. The rate of death from cardiovascular causes was also higher in this group (3.9% vs 2.2%, p=0.01). In summary, clopidogrel in addition to low-dose aspirin is not significantly more effective than low-dose aspirin alone in reducing the rate of MI, stroke, or death from cardiovascular causes. Use of clopidogrel in addition to low-dose aspirin may be harmful in patients with multiple atherothrombotic risk factors without cardiovascular disease.
Dental Health: Effects on Dental Treatment
Aspirin and clopidogrel (Plavix®) in combination is the primary prevention strategy against stent thrombosis after placement of drug-eluting metal stents in coronary patients. Premature discontinuation of this combination antiplatelet therapy strongly increases the risk of a catastrophic event of stent thrombosis leading to myocardial infarction and/or death, so says a science advisory issued in January 2007 from the American Heart Association in collaboration with the American Dental Association and other professional healthcare organizations. The advisory stresses a 12-month therapy of aspirin and Plavix® combination after placement of a drug-eluting stent in order to prevent thrombosis at the stent site. Any elective surgery should be postponed for 1 year after stent implantation, and if surgery must be performed, consideration should be given to continuing the antiplatelet therapy during the perioperative period in high-risk patients with drug-eluting stents.
This advisory was issued from a science panel made up of representatives from the American Heart Association (AHA), the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, the American College of Surgeons, the American Dental Association (ADA), and the American College of Physicians (Grines, 2007).
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Dental Comment
There is no scientific evidence to warrant the discontinuance of clopidogrel prior to dental surgery. Patients taking one clopidogrel tablet daily as an antithrombotic and who require dental surgery should be given special consideration in consultation with physician.
Mental Health: Effects on Mental Status
May cause depression, dizziness, confusion, hallucinations, insomnia, or anxiety
Mental Health: Effects on Psychiatric Treatment
GI side effects are common; concurrent use with SSRIs and/or valproic acid may produce additive effects. Flu-like syndrome may occur and present like SSRI-discontinuation symptoms. Hematologic side effects have rarely been reported; monitor with clozapine, carbamazepine, and valproate.
Nursing: Physical Assessment/Monitoring
Assess effectiveness or interactions of other medications patient may be taking. Clopidogrel is a P450 enzyme inhibitor. Monitor for unusual bleeding. Monitor therapeutic effectiveness and teach patient appropriate use, interventions to reduce side effects, and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet:
Plavix®: 75 mg, 300 mg
Pricing: U.S. (www.drugstore.com)
Tablets (Plavix)
75 mg (30): $135.99
References
“A Randomized, Blinded, Trial of Clopidogrel Versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE). CAPRIE Steering Committee,” Lancet, 1996, 348(9083):1329-39.
Adams HP, del Zoppo G, Alberts MJ, et al, “Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups,” Stroke, 2007, 38(5):1655-1711. Available at http://stroke.ahajournals.org/cgi/reprint/STROKEAHA.107.181486
Anderson JL, Adams CD, Antman EM, et al, “ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients with Unstable Angina/Non ST-Elevation Myocardial Infarction) Developed in Collaboration With the American College of Emergency Physicians, The Society of Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons,” J Am Coll Cardiol, 2007, 50(7):1-157. Available at http://content.onlinejacc.org/cgi/reprint/50/7/e1
Antman EM, Anbe DT, Armstrong PW, et al. “ACC/AHA 2007 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction),” J Am Coll Cardiol, 2004, 44(3):671-719. Available at http://www.acc.org/qualityandscience/clinical/guidelines/stemi/Guideline1/index.htm
Bal dit Sollier C, Mahe I, Berge N, et al, “Reduced Thrombus Cohesion in an ex vivo Human Model of Arterial Thrombosis Induced by Clopidogrel Treatment: Kinetics of the Effect and Influence of Single and Double Loading-Dose Regimens,” Thromb Res, 2003, 111(1-2):19-27.
Berger PB, Bell MR, Rihal CS, et al, “Clopidogrel Versus Ticlopidine After Intracoronary Stent Placement,” J Am Coll Cardiol, 1999, 34(7):1891-4.
Bertrand ME, Rupprecht HJ, Urban P, et al, “Double-Blind Study of the Safety of Clopidogrel With and Without a Loading Dose in Combination With Aspirin Compared With Ticlopidine in Combination With Aspirin After Coronary Stenting,” Circulation, 2000, 102(6):624-9.
Bhatt DL, Fox KA, Hacke W, et al, “Clopidogrel and Aspirin Versus Aspirin Alone for the Prevention of Atherothrombotic Events,” N Engl J Med, 2006, 354(16):1706-17.
Chen ZM, Jiang LX, Chen YP, et al, “Addition of Clopidogrel to Aspirin in 45,852 Patients With Acute Myocardial Infarction: Randomized Placebo-Controlled Trial. COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) Collaborative Group,” Lancet, 2005, 366(9497):1607-21.
Grines CL, Bonow RO, Casey DE, et al, “AHA/ACC/SCAI/ACS/ADA Science Advisory, Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents. A Science Advisory From the American Heart Association, American College of Cardiology, Society of Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association With Representation from the Amercian College of Physicians,” Circulation, 2007, 115(6):813-8. Available at http://www.acc.org/qualityandscience/clinical/pdfs/Final_Dual_Antiplatelet_Statement_010507.pdf
Hunt SA, Abraham WT, Chin MH , et al, "ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure)," available at http://www.acc.org/qualityandscience/clinical/guidelines/failure/update/index.pdf.
Kastrati A, Mehilli J, Schuhlen H, et al, “A Clinical Trial of Abciximab in Elective Percutaneous Coronary Intervention After Pretreatment With Clopidogrel,” N Engl J Med, 2004, 350(3):232-8.
Lange RA and Hillis LD, “Antiplatelet Therapy for Ischemic Heart Disease,” N Engl J Med, 2004, 350(3):277-80.
Lidell C, Svedberg LE, Lindell P, et al, “Clopidogrel and Warfarin: Absence of Interaction in Patients Receiving Long-Term Anticoagulant Therapy for Nonvalvular Atrial Fibrillation,” Thromb Haemost, 2003, 89(5):842-6.
Mehta SR, Yusuf S, Peters RJ, et al, “Effects of Pretreatment With Clopidogrel and Aspirin Followed by Long-Term Therapy in Patients Undergoing Percutaneous Coronary Intervention: The PCI-CURE Study,” Lancet, 2001, 358(9281):527-33.
Mishkel GJ, Aguirre FV, Ligon RW, et al, “Clopidogrel as Adjunctive Antiplatelet Therapy During Coronary Stenting,” J Am Coll Cardiol, 1999, 34(7):1884-90.
Moussa I, Oetgen M, Roubin G, et al, “Effectiveness of Clopidogrel and Aspirin Versus Ticlopidine and Aspirin in Preventing Stent Thrombosis After Coronary Stent Implantation,” Circulation, 1999, 99(18):2364-6.
Patti G, Colonna G, Pasceri V, et al, “Randomized Trial of High Loading Dose of Clopidogrel for Reduction of Periprocedural Myocardial Infarction in Patients Undergoing Coronary Intervention: Results From the ARMYDA-2 (Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty) Study,” Circulation, 2005, 111(16):2099-106.
Sabatine MS, Cannon CP, Gibson CM, et al, “Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction With ST-Segment Elevation,” N Engl J Med, 2005, 352(12):1179-89.
“Seventh ACCP Consensus Conference on Antithrombotic and Thrombolytic Therapy,” Chest, 2004, 126(3 Suppl):172-608.
Scirica BM, Sabatine MS, Morrow DA, et al. “The Role of Clopidogrel in Early and Sustained Arterial Patency After Fibrinolysis for ST-segment Elevation Myocardial Infarction. The ECG Clarity-TIMI 28 Study,” J Am Coll Cardiol, 2006, 48(1):37-42.
Steinhubl SR, Berber PB, Mann JT, et al, “Early and Sustained Dual Oral Antiplatelet Therapy Following Percutaneous Coronary Intervention. A Randomized Controlled Trial,” JAMA, 2002, 288(19):2411-20.
Yusef S, Zhao F, Mehta SR, et al, “Effects of Clopidogrel in Addition to Aspirin in Patients With Acute Coronary Syndromes Without ST-Segment Elevation,” N Engl J Med, 2001, 345(7):494-502.
International Brand Names
Lexi-Comp.com
Last full review/revision April 2008
Content last modified April 2008
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