Volume 9, Number 8, November 2002

Clopidogrel in coronary artery disease
Scott A Harding, Keith AA Fox

Platelets play a central role in both acute coronary syndromes and the ischaemic complications following percutaneous coronary intervention (PCI). Aspirin is a relatively weak antiplatelet agent and only inhibits one of many pathways leading to platelet activation. The thienopyridines, ticlopidine and clopidogrel inhibit platelet activation via the adenosine diphosphate (ADP) pathway.
Ticlopidine, the first generation thienopyridine, is effective in reducing cardiovascular events but is associated with serious haematological toxicity that has limited its use. Clopidogrel, the second generation thienopyridine has improved tolerability and safety. The CAPRIE trial demonstrated that treatment with clopidogrel in patients with vascular disease is associated with a modest reduction in vascular events when compared to aspirin therapy. The CURE trial found that the addition of clopidogrel to aspirin in patients with non-ST segment elevation acute coronary syndromes resulted in a 20% relative risk reduction in the combined end point of cardiovascular death, myocardial infarction or stroke. This benefit was at the cost of a 1% increase in major bleeding. In addition the combination of clopidogrel and aspirin is effective in preventing periprocedural ischaemic events in patients undergoing PCI.

Br J Cardiol 2002;9:S8-S12.

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