Clopidogrel

Indications

• • Prevention of vascular ischemic events in patients with symptomatic atherosclerosis

  • Acute coronary syndrome without ST-segment elevation (NSTEMI)

  • ST elevation MI (STEMI)

  • prevention of thrombosis after placement of intracoronary stent

Administration/Absorption

• • oral

  • Absorption is at least 50%

Distribution

Mechanism

• • thienopyridine class antiplatelet agent

  • activated in the liver by cytochrome P450 enzymes, including CYP2C19

  • acts by forming a disulfide bridge with the platelet ADP receptor

Excretion

• • elimination half-life of about eight hours

Side effects

• • Severe neutropenia (low white blood cells) (Incidence: 1/2,000)

  • Thrombotic thrombocytopenic purpura (TTP) (Incidence: 4/1,000,000 patients treated)^[15][16]

  • Hemorrhage - The annual incidence of hemorrhage may be increased by the co-administration of aspirin.^[17]

    • • Gastrointestinal Hemorrhage (Incidence: 2.0% annually)

      • Cerebral Hemorrhage (Incidence: 0.1 to 0.4% annually)

      • Use of non-steroidal anti-inflammatory drugs is discouraged in those taking clopidogrel due to increased risk of digestive tract hemorrhage

Interactions

Contraindications