Document Detail


The role of clopidogrel in the management of acute coronary syndromes.
MedLine Citation:
PMID:  14512126     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite significant advances in the management of coronary heart disease, myocardial infarction (MI) is still associated with a mortality rate of 45%. Acetylsalicylic acid (ASA) has been the oral antiplatelet drug of choice until recently. Thienopyridines such as clopidogrel have been shown to provide significant benefits in the management of acute coronary syndromes (ACS), either as an alternative to or in combination with ASA therapy. OBJECTIVE: The purpose of this article was to review the available scientific literature evaluating the use of clopidogrel in the management of ACS. METHODS: Relevant published data were identified through searches of the English-language literature indexed on MEDLINE and International Pharmaceutical Abstracts through April 2003. Search terms included thienopyridines, platelet aggregation inhibitors, clopidogrel, ticlopidine, acute coronary syndrome, myocardial infarction, and percutaneous coronary intervention. Pertinent conference abstracts were also included. RESULTS: The results of 3 large clinical trials-Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE), Effect of Pretreatment with Clopidogrel and Aspirin Followed by Long-Term Therapy in Patients Undergoing Percutaneous Coronary Intervention (PCI-CURE), and Clopidogrel for the Reduction of Events During Observation (CREDO)-support prolonged use of clopidogrel (up to 12 months) in combination with ASA in patients with non-ST-segment elevation MI and patients undergoing a percutaneous coronary intervention (PCI). A significant increase in bleeding events was observed in the group that received clopidogrel plus ASA compared with ASA alone in the CURE (major bleeding, P = 0.001; minor bleeding, P < 0.001) and PCI-CURE (minor bleeding, P = 0.03) trials. Use of the combination of clopidogrel and ASA with other antiplatelet and/or anticoagulant agents has not been studied extensively. CONCLUSIONS: Use of the combination of clopidogrel and ASA for up to 9 months is recommended for the medical management of non-ST-segment elevation MI and after a PCI. The increased risk of bleeding must be taken into account, and use of this combination with other agents that affect bleeding risk should be considered carefully.
Authors:
Anna M Wodlinger; John A Pieper
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Clinical therapeutics     Volume:  25     ISSN:  0149-2918     ISO Abbreviation:  Clin Ther     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-09-26     Completed Date:  2004-01-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7706726     Medline TA:  Clin Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2155-81     Citation Subset:  IM    
Affiliation:
Temple University School of Pharmacy, Philadelphia, Pennsylvania 19140, USA. awodling@temple.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Angina, Unstable / drug therapy
Aspirin / adverse effects,  pharmacology,  therapeutic use
Clinical Trials as Topic
Coronary Disease / drug therapy*
Cost-Benefit Analysis
Drug Interactions
Hemorrhage / chemically induced,  prevention & control
Humans
Platelet Aggregation Inhibitors / adverse effects,  pharmacology,  therapeutic use*
Ticlopidine / adverse effects,  analogs & derivatives*,  pharmacology,  therapeutic use*
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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