Myocardial infarction clopidogrel

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... 

Kerr JL, Oppelt TF, Rowen RC. Role of clopidogrel in unstable angina and non-ST-segment elevation myocardial infarction from literature and guidelines to practice. Pharmacotherapy. 2004 24 1037-1049. 

Activation of platelets is considered an essential process for arterial thrombosis. Thus, treatment with platelet-inhibiting drugs such as aspirin and ticlopidine or clopidogrel is indicated in patients with transient ischemic attacks and strokes or unstable angina and acute myocardial infarction. In angina and infarction, these drugs are often used in conjunction with -blockers, calcium channel blockers, and fibrinolytic drugs. 

Matetzky S, Shenkman B, Guetta V et al. Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction, Circulation 2004 109 3171-3175. 

Sabatine MS, McCabe CH, Gibson CM, Cannon CP Design and rationale of Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis in Myocardial Infarction (CLARITY-TIMI) 28trial. Am HeartJ 2005 149 227-233. 

Sabatine MS, Cannon CP Gibson CM, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med 2005 352 1 179-1 189. 

COMMIT collaborative group. Addition of Clopidogrel to aspirin in 45852 patients with acute myocardial infarction randomized placebo controlled trial. Lancet 2005 366 1607-1621. 

Sabatine MS, Cannon CR Gibson CM. Clopidogrel as adjunctive reperfusion therapy (CLARITY)-thrombolysis in myocardial infarction (TIM I) 28 investigators. Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics the PCI-CLARITY study. JAMA 2005 294(10) 1224-1232. 

The AHA/ASA guidelines recommend that antiplatelet therapy as the cornerstone of antithrombotic therapy for the secondary prevention of ischemic stroke and should be used in noncardioembolic strokes. Aspirin, clopidogrel, and extended-release dipyridamole plus aspirin are aU considered first-line antiplatelet agents (see Table 13-1). The combination of aspirin and clopidogrel can only be recommended in patients with ischemic stroke and a recent history of myocardial infarction or coronary stent placement and then only with ultra-low-dose aspirin to minimize bleeding risk. 

PROTON PUMP INHIBITORS CLOPIDOGREL Patients after myocardial infarction on dopidogrel were more likely to suffer reinfarction with concomitant proton pump inhibitor treatment Proton pump inhibitors inhibit CYP2C19, which converts dopidogrel to the active metabolite Pantoprazole is not known as yet to cause this effect. Consider using acid suppression therapy with H2 blockers when dopidogrel is used as secondary prevention of coronary heart disease... 

Antiplatelet therapy (aspirin or clopidogrel) reduces the incidence of fatal and of nonfatal myocardial infarction in patients with unstable angina, used alone or with low-dose heparin. 

The efficacy of clopidogrel as an antiplatelet agent in atherothrombotic disorders was demonstrated in the CAPRIE trial. In this study of more than 19,000 patients with a history of either myocardial infarction (MI), stroke, or peripheral arterial disease (PAD), clopidogrel 75 mg/day was compared with aspirin 325 mg/day for its ability to decrease MI, stroke, or cardiovascular death. In the final analysis, clopidogrel was slightly (8% relative risk reduction [RRR]) more effective than aspirin (p =. 043) and had a similar incidence of adverse effects. It is not associated with the blood dyscrasias (neutropenia) common with its congener, ticlopidine, and is used widely in patients with atherosclerosis. 

Chen ZM, Jiang LX, Chen YP, et al. COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction randomised placebo-con-trolled trial. Lancet 2005 366(9497) 1607—21. 

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