Clopidogrel, safety

Cattaneo M (2004) Aspirin and clopidogrel efficacy, safety, and the issue of drag resistance. Arterioscler Thromb Vase Biol 24 1980-1987... 

Lactation Studies in rats have shown that clopidogrel and its metabolites are excreted in milk. It is not known whether this drug is excreted in human breast milk. Chiidren Safety and efficacy have not been established. 

The results showed that patients treated with clopidogrel had an annual 5,32% risk of ischemic stroke, Ml, or vascular death compared with 5,83% with aspirin (RRR = 8.7% in favor of clopidogrel, P = 0,045). There were no major differences in terms of safety. 

Bertrand ME, Rupprecht HJ, Urban R Gershlick AH, Investigators FT, Double-blind study ofthe safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting the clopidogrel aspirin stent international cooperative study (CLASSICS). Circulation 2000 102 624-629,... 

The CURE trial investigated the efficacy and safety of clopidogrel in 12,562 patients when administered together with aspirin in patients with ACS (UA or non-Q-wave Ml). The combination demonstrated a 20% relative risk reduction in the combined endpoints of Ml, stroke, or cardiovascular death compared with placebo (31). 

The most important safety concerns are the potential for perforation which could result in tamponade or compromise of collaterals which can result in infarction. In current PCI practice with its reliance on drug eluting stent (DES), dual antiplatelet therapy with aspirin (ASA) and a thienopyridine (usually clopidogrel) is standard. These should be used in all patients. Pre-procedure administration of the thienopyridine should be given, if possible. 

Lincoff AM, Steinhubl SR, Manoukian SV, et al. Influence of timing of clopidogrel treatment on the efficacy and safety of bivalirudin in patients with non-ST-elevation acute coronary syndromes undergoing percutaneous coronary intervention. An analysis of the ACUITY Trial. JACC Cardiovasc Interv 2008 l(6) 639-48. 

Substantial evidence supports the use of the thienopyridine clo-pidogrel in patients with UA/NSTEMI who are treated medically or who undergo PCI with stenting (67,68). Clopidogrel is also used, in combination with aspirin, following elective PCI with stenting (69). Information on the efficacy and safety of dual antiplatelet therapy with... 

Orford JL, Fasseas P, Melby S, Burger K, Steinhubl SR, Holmes DR, Berger PB. Safety and efficacy of aspirin, clopidogrel, and warfarin after coronary stent placement in patients with an indication for anticoagulation. Am Heart J (2004) 147, 463-7. 

Oflier safety concerns with PPIs include the suggested inhibition of the antiplatelet effects of clopidogrel leading to an increased risk of vascular events, and associations with bone fractures, hypomagnesemia, and pneumonia. 

Martinez Salazar GM, Tan CS, Spearman K, Wicky S, Wu S Safety of percutaneous tunneled hemodialysis catheter procedures in patients receiving concurrent clopidogrel therapy. J Vase Access 2014 15 33-37. 

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