Clopidogrel (
Plavix),
Iscover) selectively and irreversibly inhibits
adenosine diphosphate (
ADP)-induced platelet aggregation. Long-term administration of
clopidogrel was associated with a modest but statistically significant advantage over
aspirin in reducing adverse cardiovascular outcomes in patients with established
cardiovascular disease in the CAPRIE trial. In other large well designed multicentre trials, such as CURE, COMMIT and CLARITY-TIMI 28, the addition of
clopidogrel to
aspirin therapy improved outcomes in patients with
acute coronary syndromes. However, some issues regarding the use of
clopidogrel remain unresolved, such as the optimal loading dose in patients undergoing
percutaneous coronary interventions (PCI) and the optimal
treatment duration following drug-eluting intracoronary
stent placement. Results of several large randomised trials, therefore, have established
clopidogrel as an effective and well tolerated
antiplatelet agent for the
secondary prevention of ischaemic events in patients with various cardiovascular conditions, including those with
ischaemic stroke or
acute coronary syndromes. In addition, treatment guidelines from the US and Europe acknowledge the importance of
clopidogrel in contemporary cardiovascular medicine.