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)

Read more at Wikipedia.org


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Patients need not stop clopidogrel before surgery
From OB/GYN News, 5/1/05 by Mitchel L. Zoler

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 was sponsored by the Cardiovascular Research Institute at Washington Hospital Center.

"There is growing experience that it's safe to perform surgery on a patient taking clopidogrel. At our institution, surgeons will operate on these patients. There is no significant difference in morbidity and mortality" during surgery, said Dr. Kuntz, who is a cardiologist at Brigham and Women's Hospital in Boston.

"Surgeons make more of a big deal about clopidogrel than they need to," he added.

This approach to dealing with patients on long-term treatment with the antiplatelet drug clopidogrel (Plavix) was endorsed also by Ron Waksman, M.D., of the division of cardiology at the Washington Hospital Center.

"If we push our surgeons, they'll do surgery without waiting to stop clopidogrel," said Dr. Waksman, who chaired the meeting.

The issue of when to stop clopidogrel recently became critical for patients who take the drug after they have received drug-eluting coronary stents. A report last year detailed four anecdotal cases of patients who developed clinically significant coronary thrombosis within a drug-eluting stent after their clopidogrel and aspirin regimens were stopped (Lancet 2004;364:1519-21).

In three of these cases, patients had stopped their antiplatelet medications before surgery.

These reports have made experts wary about stopping aspirin and clopidogrel in their patients.

COPYRIGHT 2005 International Medical News Group
COPYRIGHT 2005 Gale Group

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