Clopidogrel contraindications

Antiplatelet therapy with aspirin should be considered for all patients without contraindications, particularly in patients with a history of myocardial infarction. Clopidogrel may be considered in patients with allergies or intolerance to aspirin. In some patients, combination antiplatelet therapy with aspirin and clopidogrel may be used. 

Aspirin decreases the risk of death, recurrent infarction, and stroke following myocardial infarction. Aspirin prescription at hospital discharge is a quality care indicator in MI patients.3 All patients should receive aspirin indefinitely those patients with a contraindication to aspirin should receive clopidogrel.2,3... 

Clopidogrel may be substituted for aspirin when aspirin is absolutely contraindicated Long-acting nondihydropyridine calcium antagonists instead of /3-blockers as initial therapy ACEIs are recommended in patients with CAD or other vascular disease Low-intensity anticoagulation with warfarin, in addition to aspirin, is recommended but bleeding would be increased Therapies to be avoided include ... 

Aspirin (75-325 mg daily) administrated on a routine basis is highly recommended in all patients with acute and chronic ischemic heart disease if the patient has no contraindications. Clopidogrel will be the possible alternate choice if aspirin is totally... 

There is very strong evidence for the beneficial effects of Aspirin and it should be started as soon as possible. Clopidogrel has to be used as an alternative for aspirin if the latter is contraindicated in hospitalized patients. Otherwise, this drug has to be added to... 

For long term therapy. Aspirin 75-325 mg per day or Clopidogrel 75 mg per day, when Aspirin is contraindicated, is strongly recommended. Combination of Aspirin and Clopidogrel for 9 months, and... 

Thus, clopidogrel has to be considered a safe alternative to aspirin for secondary prevention in patients with stable coronary artery disease, It should be given to all patients with coronary artery disease and who have either a contraindication or intolerance to aspirin. 

Antiplatelet therapy plays a key role in the treatment of ACS, such as Ml. Aspirin has been shown to decrease overall mortality and reinfarction and is recommended for all patients in this setting unless contraindicated. Aspirin should be given at the lowest effective dose, to ensure efficacy and to limit adverse reactions. If aspirin is contraindicated or not tolerated, thienopyridines (clopidogrel or ticlopidine) may be used. Comparisons of oral antiplatelet agents are summarized in Thumbnail. 

More recently, Tran and Anand conducted a systematic review of the literature in an effort to summarize the best evidence for oral antiplatelet therapy in patients with cerebrovascular disease, CAD, and PAD. This review included 111 trials (42 of which included patients with PAD, n = 9214) and concluded that patients with PAD should use ASA (160 to 325 mg/day) or clopidogrel (75 mg/day) when ASA is not tolerated or contraindicated. This is in concordance with the recommendations of the Seventh American College of Chest Physicians (ACCP) Conference on Antithrombotic and Thrombolytic Therapy which recommends lifelong ASA (75 to 325 mg/day) over clopidogrel, ticlopidine, and no antithrombotic therapy in patients with PAD. Unfortunately, no data are currently avaUable from large, clinical, randomized trials that ASA, or any other antiplatelet therapies, can actually prevent or delay the progression of PAD. ... 

Caution must be employed when eptifibatide is used with other drugs that affect haemostasis, including clopidogrel, ticlopidine, dipyridamole, oral anticoagulants or thrombolytics and concurrent or planned use of another glycoprotein Ilb/IIIa inhibitor is contraindicated. ... 

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