Use of Clopidogrel

Source: http://www.heartcarewa.com.au/facts7.php

WHO SHOULD HAVE IT AND FOR HOW LONG?

Clopidogrel alone:
Patients for whom Aspirin is indicated but where there is:

• Allergy to aspirin or NSAID
• Unacceptable risk of GI bleeding with Aspirin

Clopidogrel combined with Aspirin:

1. (i) Acute coronary syndrome (unstable angina or non-STEMI) patients (irrespective of whether angiography +/- subsequent stenting is performed and STEMI) – for at least 12 months.
   
   (ii) Post coronary stenting - for at least 12 months if a drug eluting stent is used.
   - for 3-4 months if a bare metal stent is used.
   
   If Clopidogrel therapy needs to be discontinued for any reason within these time frames it is very important for management to be discussed with the patient’s cardiologist in view of the risk of acute stent thrombosis.
   
   
2. Patients who have an ischaemic event (cardiac or neurological) while on Aspirin – indefinite.
   
   
3. High vascular risk patients
   
   - diabetic with vascular disease
   - previous CABG surgery
   - known severe vascular disease
   - recurrent ischaemic episodes (cerebral or cardiac) benefit demonstrated for up to one year.
   
   (Combination therapy has not been shown to be of benefit for primary prevention, even in high risk individuals)
   

NOTE:

• One recent study has indicated that taking proton pump inhibitors concurrently with Clopidogrel, may decrease antiplatelet activity. Somac does not have this effect and until the situation is clarified, it may be prudent for patients to switch to Somac if they are taking Clopidogrel. Patients should not stop Clopidogrel without seeking definitive medical advice.
• The addition of Clopidogrel to Aspirin increases the risk of serious bleeding by 2.7 to 3.7%.
• Nearly all patients with the above indications qualify for approval of Clopidogrel under the Australian PBS schedule.
  
• Contraindications to Clopidogrel
  - hypersensitivity
  - active pathological bleeding such as peptic ulcer or intra-cranial haemorrhage.

Dr Bernard Hockings
R.F.D.  M.D. (WA)  M.B.B.S. (WA)  F.R.A.C.P.  F.C.S.A.N.Z.
Clinical Associate Professor in Medicine UWA
Reference :2002 European Society of Cardiology Guidelines
Reviewed February 2009

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