Date - 23 August 2004

Source - Drugs in Context 2004; 1A(3): Clopidogrel - Atherothrombosis p87

Author - Dr Scott Chambers

The thienopyridine, clopidogrel, is an antiplatelet agent that has proven efficacy in the management of atherothrombosis. A number of landmark clinical trials have demonstrated its efficacy across a variety of patient populations. The CAPRIE study (Clopidogrel vs Aspirin in Patients at Risk of Ischaemic Events) was the first secondary prevention trial which demonstrated a significantly greater risk reduction with an antiplatelet agent (clopidogrel) in comparison with aspirin. The CURE study (Clopidogrel in Unstable Angina to Prevent Recurrent Events) has shown that clopidogrel, when administered in combination with aspirin, is more effective than aspirin monotherapy in reducing a range of vascular events in patients with acute coronary syndromes (ACS). There is also emerging evidence supporting the combination of clopidogrel and aspirin both during and after percutaneous coronary revascularisation. Finally, ongoing trials are specifically evaluating the role of clopidogrel in the treatment of peripheral arterial disease (PAD), ischaemic stroke and transient ischaemic attacks (TIAs). Clopidogrel has been shown to be well tolerated across its clinical development programme and has an adverse event profile similar to aspirin, although the incidence of gastrointestinal disturbances appears to be lower with clopidogrel. However, when clopidogrel is combined with aspirin in the CURE study, major and minor bleeding events are increased compared with monotherapy, but this appears to be dependent on the dose of aspirin employed.

Keywords: Clopidogrel, Atherothrombosis