Related Experiment Videos

Systematic review of thienopyridine discontinuation and its impact upon clinical outcomes

Michael A Gaglia1, Ron Waksman

  • 1Division of Cardiology, Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA.

European Heart Journal
|August 2, 2011
PubMed

Insights

Determining optimal clopidogrel therapy length is crucial. Discontinuation risks, especially within the first month post-PCI or six months post-stenting, are significant, particularly with drug-eluting stents.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • The optimal duration of clopidogrel therapy after acute coronary syndromes or percutaneous coronary intervention (PCI) is not well-established.
  • Clopidogrel is a critical antiplatelet medication used to prevent thrombotic events.

Purpose of the Study:

  • To evaluate the risks associated with perioperative and premature discontinuation of clopidogrel therapy.
  • To identify patient populations and timeframes with the highest risk of adverse events following clopidogrel cessation.

Main Methods:

  • A systematic literature search was conducted using PubMed and EMBASE databases from January 2000 to March 2010.
  • Included studies reported adverse clinical events related to clopidogrel discontinuation in English.

Main Results:

  • Observational studies suggest a hazard for adverse cardiac events with perioperative clopidogrel cessation, particularly in the first month post-PCI.
  • Retrospective studies on premature discontinuation indicate the highest risk within the first six months after stenting, with potentially higher risks associated with drug-eluting stents (DESs).

Conclusions:

  • Current evidence on the optimal length of clopidogrel therapy is limited due to the observational and retrospective nature of existing studies.
  • Further randomized clinical trials are needed to definitively establish the optimal duration of clopidogrel therapy and safe discontinuation windows.

Related Concept Videos

Therapeutic Drug Monitoring: Affecting Factors01:29

Therapeutic Drug Monitoring: Affecting Factors

Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
Therapeutic Drug Monitoring: Overview and Classification01:16

Therapeutic Drug Monitoring: Overview and Classification

Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood at designated intervals to ensure the drug concentration stays within a therapeutic range. This monitoring is crucial for optimizing individual dosage regimens, enhancing therapeutic efficacy, and minimizing drug-related toxicity. TDM is vital for drugs with narrow therapeutic windows, significant variability in pharmacokinetics, and a clear correlation between plasma levels and...
Desensitization and Tachyphylaxis01:20

Desensitization and Tachyphylaxis

Tachyphylaxis is described as a rapid decrease in response to a drug after repeated or continuous administration of the same drug dose. It is a phenomenon where the body becomes less responsive to a particular substance or intervention over time, requiring higher doses or stronger interventions to achieve the same effect. It results from adaptive changes in the body's receptors, signaling pathways, or physiological processes that occur in response to prolonged exposure to a stimulus.
Several...
Antihypertensive Drugs: Thiazide-Class Diuretics01:15

Antihypertensive Drugs: Thiazide-Class Diuretics

Thiazide diuretics are sulfonamide derivatives featuring a benzothiadiazine ring system in their molecular structure. Based on this structure, thiazide diuretics can be categorized into two groups: thiazide-type and thiazide-like diuretics. Thiazide-type diuretics, including hydrochlorothiazide and chlorothiazide, consist of a benzothiadiazine backbone with an attached sulfonamide group. Thiazide-like diuretics, such as chlorthalidone and indapamide, lack the thiazide ring but demonstrate...
Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment

Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
Therapeutic Drug Monitoring: Drug Analysis Methods01:26

Therapeutic Drug Monitoring: Drug Analysis Methods

Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood or body tissues to tailor drug therapy effectively. This monitoring is critical for managing drugs with narrow therapeutic indices like digoxin and phenytoin, ensuring they are both safe and effective. For instance, monitoring theophylline levels in asthma patients involves precision and sensitivity to adjust doses according to individual responses to therapy, ensuring efficacy and...