Role of Clopidogrel in Managing Atherothrombotic Cardiovascular Disease

20 March 2007 | Volume 146 Issue 6 | Pages 434-441

Aspirin is the most widely used antiplatelet agent for preventing and treating vascular events. The thienopyridine derivatives, ticlopidine and clopidogrel, are a suitable alternative in patients who are intolerant to aspirin, and clopidogrel exhibits better tolerability than ticlopidine. The available evidence from randomized trials indicates that dual therapy with clopidogrel and aspirin is modestly but significantly more effective than aspirin in preventing serious vascular events. It is also associated with a favorable benefit–risk profile in patients at high risk (especially in acute coronary syndromes and after stenting). In patients at low risk (stable cardiovascular disease), however, the bleeding risk of dual therapy exceeds its potential benefit. The dose and duration of pretreatment before stenting, the optimal duration of treatment after drug-eluting stent implantation, concurrent administration of platelet glycoprotein IIb/IIIa inhibitors, and the exact mechanism and clinical relevance of clopidogrel resistance are unclear.

Author and Article Information

From the Cedars-Sinai Medical Center and the David Geffen School of Medicine, University of California, Los Angeles, California.

Grant Support: None.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Sanjay Kaul, MD, Division of Cardiology, Room 5536, South Tower, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048; e-mail, kaul{at}cshs.org.

Current Author Addresses: Drs. Eshaghian, Kaul, Amin, Shah, and Diamond: Division of Cardiology, Room 5536, South Tower, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048.