Chemical struction of clopidogrel bisulfate
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Clopidogrel

Clopidogrel, which is often prescribed under the brand name Plavix® (clopidogrel bisulfate; produced by Bristol-Myers Squibb and Sanofi-Aventis), is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. more...

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Pharmacology

The mechanism of action of clopidogrel is irreversible blockade of the adenosine diphosphate (ADP) receptor on platelet cell membranes. This receptor is named P2Y12 and is important in platelet aggregation, the cross-linking of platelets by fibrin. The blockade of this receptor inhibits platelet aggregation.

Two hours after a single dose of oral Plavix®, platelet inhibition can be demonstrated.

Pregnancy category

Clopidogrel is pregnancy category B. This means that in animal models, there is no risk of adverse effects in doses equivalent to doses that a pregnant female would ingest. The implication is that the medication is probably safe to administer during human pregnancy. It is currently unknown whether clopidogrel is excreted in human breast milk.

Adverse effects

Serious adverse effects that are associated with clopidogrel include:

  • Severe neutropenia (Incidence: 5/10,000)
  • Thrombotic thrombocytopenic purpura (TTP) (Incidence: 4/1,000,000 patients treated)
  • Hemorrhage - The incidence of hemorrhage may be increased by the co-administration of aspirin.
    • Gastrointestinal Hemorrhage (Incidence: 2.0%)
    • Cerebral Hemorrhage (Incidence: 0.1 to 0.4%)

Most consensus-based therapeutic guidelines recommend the use of clopidogrel, over aspirin, in patients requiring antiplatelet therapy but with a history of gastric ulceration due to the lower incidence of gastric ulceration associated with the use of clopidogrel vs aspirin. A recent study has shown that in patients with healed aspirin-induced ulcers, however, patients receiving aspirin plus the proton pump inhibitor esomeprazole had a lower incidence of recurrent ulcer bleeding than patients receiving clopidogrel. (Chan et al., 2005)

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Cost effectiveness of aspirin vs clopidogrel for secondary prevention of coronary heart disease - Patient-Oriented Evidence that Matters - Brief Article
Gaspoz JM, Coxson PG, Goldman PA, et al. Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease. N Engl ...
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PURPOSE: Platelet-rich intracoronary thrombus is central to the pathogenesis of acute coronary syndrome, and patients scheduled for coronary artery bypass graft (CABG) surgery today are receiving m
Clopidogrel as antithrombotic therapy in atrial fibrillation
To the Editor: Clopidogrel is a new antiplatelet drug that has been largely used in several settings of coronary artery disease. Its role in the prevention ...
The value of clopidogrel administered postoperatively following a non-ST-segment elevation acute coronary syndrome
To the Editor: In their recent article in CHEST (September 2004) (1) on antithrombotic therapy, Stein et al recommended that clopidogrel be added to aspirin for 9 to 12 months in patients undergo
Aspirin plus PPI or clopidogrel in patients with GI bleeding?
Clinical Question: What is the best anti-thrombotic for patients with a history of upper gastrointestinal (GI) bleeding? Setting: Inpatient (any location) ...
Patients need not stop clopidogrel before surgery
WASHINGTON -- Patients on long-term clopidogrel treatment don't need to stop the drug before surgery, Richard E. Kuntz, M.D., said at a meeting that ...
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Antiplatelet therapy with clopidogrel has provided significant secondary prevention for patients with transient ischemic attacks (TIA) and ischemic stroke. The effect was superior to aspirin and va

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