Clopidogrel After Coronary Stenting

Five randomized trials have conclusively demonstrated that aspirin and ticlopidine are more effective than aspirin and Coumadin (DuPont Merck Pharmaceutical Co., Wilmington, DE), or aspirin alone, at preventing thrombosis and other ischemic complications after stent placement. However, side effects from ticlopidine are common, the most serious of which are neutropenia and thrombotic thrombocytopenic purpura. Another problem with ticlopidine is its slow onset of action. Recent observational data from several centers and data from a randomized trial indicate that clopidogrel, which can be administered with large loading doses that are well tolerated and speed the onset of action, is at least as effective as ticlopidine. Clopidogrel has far fewer side effects as well. Questions remain about the most appropriate loading dose of clopidogrel and duration of therapy after stent placement.