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Clopidogrel: cardiologists' panacea or neurologists' headache?
Daniel C Bezerra1, Julien Bogousslavky
1Department of Neurology, Centre Hospitalier Universitaire Vaudois(CHUV), Lausanne, Switzerland. danielcbezerra@hotmail.com
Insights
Clopidogrel effectively prevents atherothrombotic events in patients with atherosclerotic disease and acute coronary syndromes. However, its benefit in cerebrovascular disease patients receiving standard clopidogrel therapy remains unproven.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Clinical Trials
Background:
- Clopidogrel is a key antiplatelet medication.
- Established atherosclerotic disease and acute coronary syndromes show benefits with clopidogrel.
Purpose of the Study:
- To review the efficacy of clopidogrel in preventing atherothrombotic events.
- To analyze clopidogrel's role in various patient populations and clinical settings.
Main Methods:
- Review of major clinical trials including CAPRIE, CURE, CREDO, CLARITY-TIMI 28, COMMIT/CCS-2, and MATCH.
- Comparative analysis of clopidogrel versus aspirin and placebo.
Main Results:
- Clopidogrel demonstrated superior efficacy to aspirin in preventing atherothrombotic events (CAPRIE study).
- Significant benefits of clopidogrel were observed in acute coronary syndromes and percutaneous coronary intervention (CURE, CREDO, CLARITY-TIMI 28, COMMIT/CCS-2).
- No additional benefit of aspirin to clopidogrel was found in patients with cerebrovascular disease (MATCH trial).
Conclusions:
- Clopidogrel is highly effective for atherothrombotic event prevention in specific cardiovascular conditions.
- The utility of adding aspirin to clopidogrel in cerebrovascular disease warrants further investigation.
Abstract:
Clopidogrel (Plavix) is a potent platelet inhibitor that has been demonstrated to be significantly more effective than aspirin for the prevention of atherothrombotic events in patients with established atherosclerotic disease in the Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) study. Furthermore, the benefit of clopidogrel compared with placebo in patients with acute coronary syndromes, as well as those undergoing percutaneous coronary intervention receiving a standard therapy including aspirin, has been largely demonstrated by the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE), Clopidogrel for the Reduction of Events During Observation (CREDO), CLopidogrel as Adjunctive ReperfusIon TherapY-Thrombolysis In Myocardial Infarction (CLARITY-TIMI)28, and Clopidogrel and Metoprolol in Myocardial Infarction Trial/Secon Chinese Cardiac Study (COMMIT/CCS-2) trials. However, in the Management of Atherothrombosis with Clopidogrel in High-risk patients with recent transient ischemic attack or ischemic stroke (MATCH) trial, there was no clinical benefit of adding aspirin versus placebo to a standard therapy of clopidogrel in patients with cerebrovascular disease. The implications of these findings, as well as future perspectives from upcoming trials, shall be discussed herein.
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