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Clopidogrel


Learning objectives

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Clopidogrel may show a delayed onset of platelet inhibition of 48 h because it requires activation by two-stage hepatic metabolism.

About : Always Clopidogrel check the BNF link here
  • Thienopyridine platelet antagonist P2Y12 receptor blocker
  • Ask cardiologist before stopping dual antiplatelet early post stenting.
Action
  • Blocks platelet activation
  • Works synergistically with Aspirin
  • Genetic variations in metabolism
Mode of action
  • Prodrug which requires activation in the liver
  • Clopidogrel blocks the activation of the platelet P2Y12 receptor - antiplatelet agent
  • Selective and irreversible inhibition of ADP binding to platelet receptors
  • Prolongs the bleeding time
Indications
  • NSTEMI (CURE study) treat for up to 1 year
  • STEMI (CLARITY study and COMMIT study) for 14 days
  • PCI patients (CLASSICS trial and PCI CURE)
  • Bare metal stent - at least one month Treatment
  • Drug eluting stent - 12 months Aspirin + Clopidogrel treatment
  • Aspirin intolerant patients requiring antiplatelet therapy
Contraindications
  • Bleeding 1% increased risk of major bleeds
  • Trauma, imminent surgery, Thrombocytopenia
interactions
  • Effects reduced by omeprazole
Dose
  • STEMI/ACS: Loading dose 300-600 mg po
  • ACS/Ischaemic Stroke/TIA:Maintenance dose 75 mg od
Side effects
  • Diarrhoea, Rash, Dyspepsia, Bleeding takes 7 days for effect to reduce.
References