Clopidogrel in coronary artery disease: update 2012

Area of Science:

• Cardiology
• Pharmacology
• Thrombosis

Background:

• Clopidogrel was the standard P2Y12 inhibitor for coronary artery disease (CAD) patients, used with aspirin.
• Newer agents, prasugrel and ticagrelor, demonstrate superior efficacy in acute coronary syndromes (ACS).
• This superiority is linked to a significant non-response rate (up to 30%) to clopidogrel in ACS patients.

Purpose of the Study:

• To review the current understanding of clopidogrel's role in CAD management.
• To summarize the latest evidence on clopidogrel's efficacy and indications.
• To highlight the continued relevance of clopidogrel in specific patient populations.

Main Methods:

• Literature review of recent studies on P2Y12 inhibitors.
• Analysis of clinical trial data comparing clopidogrel, prasugrel, and ticagrelor.
• Synthesis of information on clopidogrel response variability.

Main Results:

• While prasugrel and ticagrelor outperform clopidogrel in ACS, clopidogrel remains effective for many CAD patients.
• Genetic and non-genetic factors contribute to clopidogrel non-responsiveness in up to 30% of ACS cases.
• Clopidogrel still has a significant role in the majority of CAD patients, particularly in elective settings.

Conclusions:

• Clopidogrel continues to be a valuable antiplatelet option for a substantial portion of patients with coronary artery disease.
• Understanding patient response variability is crucial for optimizing antiplatelet therapy selection.
• This review provides an updated perspective on clopidogrel's place in modern cardiovascular pharmacotherapy.