Hostname: page-component-77c89778f8-rkxrd Total loading time: 0 Render date: 2024-07-18T05:11:15.708Z Has data issue: false hasContentIssue false
  • English
  • Français

The role of clopidogrel in the emergency department

Published online by Cambridge University Press:  21 May 2015

Payal Patel  and
Lily Cheng
Payal Patel*
Affiliation:
Evidence-Based Consultant, Evidence-Based Prescribing Initiative, London Health Sciences Centre, London, Ont.
Lily Cheng
Affiliation:
Pharmacotherapeutic Specialist, Emergency Medicine, Burnaby Hospital, Fraser Health Authority, Burnaby, BC
*
London Health Sciences Centre, Rm. S121, 375 South St., London ON N6A 4G5; 519 685-8300 x75021, fax 519 667-6811, Payal.Patel@lhsc.on.ca

Extract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Despite major advances in the management of acute coronary syndromes (ACS), 1 in 3 Canadians die from cardiovascular disease. In 1998, the total economic burden of cardiovascular illness in Canada was $159 434.5 million dollars — $83 953.9 million in direct costs and $75 479.6 in indirect costs. During the past 20 years, several pharmacologic adjuncts have been investigated with hopes of ameliorating the consequences of ACS. Notably, clopidogrel has become a common component of ACS therapeutic regimens since its introduction in 1998. Both new medications and those already accepted as standard treatment deserve critical evaluation to ensure they are safe and effective.

Keywords

ACSacute coronary syndromesclopidogrelNone declared
Type
Pharmacotherapy • Pharmacothérapie
Information
Canadian Journal of Emergency Medicine , Volume 7 , Issue 1 , January 2005 , pp. 22 - 27
Copyright
Copyright © Canadian Association of Emergency Physicians 2005

References

1.Braunwald, E, Antman, EM, Beasley, JW, Califf, RM, Cheitlin, MD, Hochman, JS, et al.ACC/AHA 2002 guideline update for the management of patients with unstable and non-ST-segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). 2002. Available: www.acc.org/clinical/guidelines/unstable/unstable.pdf (accessed 2004 Dec 15).Google Scholar
2.Heart and Stroke Foundation of Canada with the Centre for Chronic Disease Prevention and Control, Health Canada, Canadian Cardiovascular Society. The growing burden of heart disease and stroke in Canada 2003. Available: www.cvdinfobase.ca/cvdbook/CVD_En03.pdf (accessed 2004 Nov 16).Google Scholar
3.White, HD. Unmet therapeutic needs in the management of acute ischemia. Am J Cardiol 1997;80(suppl 4A):2B–10B.CrossRefGoogle ScholarPubMed
4.Mathis, AS. Newer antithrombotic strategies in the initial management of non-ST-segment elevation acute coronary syndromes. Ann Pharmacother 2000;34:208–27.CrossRefGoogle ScholarPubMed
5.Kullo, IJ, Edwards, WD, Shwartz, RS. Vulnerable plaque: pathobiology and clinical implications. Ann Intern Med 1998;129:1050–60.CrossRefGoogle ScholarPubMed
6.Theroux, P, Fuster, V. Acute coronary syndromes: unstable angina and non-Q-wave myocardial infarction. Circulation 1998;97:1195–206.Google Scholar
7.Ferguson, JJ. Conventional antithrombotic approaches. Am Heart J 1995;130:651–7.Google Scholar
8.Taniuchi, M, Kurz, HI, Lasala, JM. Randomized comparison of ticlopidine and clopidogrel after intra-coronary stent implantation in a broad patient population. Circulation 2001;104 539–43.CrossRefGoogle Scholar
9.Bertrand, ME, Rupprescht, HJ, Urban, P, Gershlick, AH. Double blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting. Circulation 2000;102:624–9.Google Scholar
10.Yusuf, S, Zhao, F, Mehta, SR, Chrolavisius, S, Tognoni, G, Fox, KK; Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation [published errata appear in N Engl J Med 2001;345(20):1506 and N Engl J Med 2001;345(23):1716]. N Engl J Med 2001;345(7):494–502.Google Scholar
11.Herbert, JM, Frehel, D, Vallee, E, Kieffer, G, Gouy, D, Berger, Y, et al. Clopidogrel, a novel antiplatelet and antithrombotic agent. Cardiovas Drug Rev 1993;2:180–98.CrossRefGoogle Scholar
12.Mills, DCB, Puri, R, Hu, CJ, Minnily, C, Grana, G, Freedman, MD, et al. Clopidogrel inhibits the binding of ADP analogues to the receptor mediating inhibition of platelet adenylate cyclase. Arterioscler Thromb 1992; 2:430–6.Google Scholar
13.Caplain, H, Donat, F, Gaud, C, Necciari, J. Pharmacokinetics of clopidogrel. Semin Thromb Hemost 1999;25(suppl 2):25–8.Google ScholarPubMed
14.Savcic, M, Hauert, J, Backmann, F, Wyld, P, Geudelin, B, Cariou, R. Clopidogrel loading dose regimens: kinetic profile of pharmacodynamic response in healthy subjects. Semin Thromb Hemost 1999;25(suppl 2):15–9.Google Scholar
15.Lau, WC, Waskell, LA, Watkins, PB, Neer, CJ, Horowitz, K, Hopp, AS, et al.Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation. A new drug-drug interaction. Circulation 2003;107:32–7.CrossRefGoogle ScholarPubMed
16.Mitsios, JV, Papathanasiou, AI, Rodis, FI, Elisaf, M, Goudevenos, JA, Tselepis, AD. Atorvastatin does not affect the antiplatelet potency of clopidogrel when it is administered concomitantly for 5 weeks in patients with acute coronary syndromes. Circulation 2004;109:1335–8.Google Scholar
17.Sharis, P, Cannon, CP, Loscalzo, J. The antiplatelet effects of ticlopidine and clopidogrel. The antiplatelet effects of ticlopidine and clopidogrel. Ann Intern Med 1998;129:394–405.Google Scholar
18.A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996;348:1329–39.Google Scholar
19.Berger, PB, Bell, MR, Rihal, CS, Ting, H, Barsness, G, Garatt, K, et al.Clopidogrel versus ticlopidine after intracoronary stent placement. J Am Coll Cardiol 1999;34:1891–4.Google Scholar
20.Moussa, I, Oetgen, M, Roubin, G, Colombo, A, Wang, X, Iyer, S, et al.Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation. Circulation 1999;99:2364–6.CrossRefGoogle ScholarPubMed
21.Muller, C, Buttner, HJ, Petersen, J, Roskamm, H. A randomized comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary-artery stents. Circulation 2000;101:590–3.CrossRefGoogle ScholarPubMed
22.Bhatt, DL, Bertrand, ME, Berger, PB, L’Allier, PL, Moussa, I, Moses, JW, et al.Meta-analysis of randomized and registry comparisons of ticlopidine with clopidogrel after stenting. J Am Coll Cardiol 2002;39:9–14.Google Scholar
23.Mehta, SR, Yusuf, S, Peters, PJ, Bertrand, ME, Lewis, BS, Natarajan, MK, et al.Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 2001;358:527–33.Google Scholar
24.Lincoff, AM, Califf, RM, Topol, EJ. Platelet glycoprotein IIb/IIIa blockade in coronary artery disease. J Am Coll Cardiol 2000;35:1103–15.Google Scholar
25.Cannon, CP, Weintraub, WS, Demopoulos, LA, Vicari, R, Frey, MJ, Lakkis, N, et al;TACTICS (Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy) — Thrombolysis in Myocardial Infarction 18 Investigators. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med 2001;344:1879–87.CrossRefGoogle ScholarPubMed
26.Steinhubl, SR, Berger, PB, Mann, JT 3rd, Fry, ET, DeLago, A, Wilmer, C, et al;CREDO Investigators. Clopidogrel for the Reduction of Events During Observation. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention [published erratum appears in JAMA 2003;289(8):987]. JAMA 2002;288(19):2411–20.CrossRefGoogle ScholarPubMed
27.Lindgren, P, Jonsson, B, Yusuf, S. Cost-effectiveness of clopidogrel in acute coronary syndromes in Sweden: a long-term model based on the cure trial. J Intern Med 2004;255:562–7.Google Scholar