Clopidogrel: how good is it and how does it work?
Until recently, long-term antiplatelet therapy for the treatment and prevention of the complications of atherothrombotic disease was limited to aspirin. Although an incredibly cost-effective therapy, in placebo-controlled clinical trials approximately 75% of patients at risk continue to experience thrombotic events despite chronic aspirin therapy. The availability of the thienopyridines, in particular clopidogrel, represents an important addition to the physician's armamentarium. A number of clinical trials have confirmed the efficacy of the combination of clopidogrel and aspirin therapy compared with aspirin alone, with multiple other important large-scale clinical trials currently ongoing. The exact mechanism of this benefit is still being elucidated but is clearly related to the inhibition of the many consequences of platelet activation--vascular inflammation, endothelial dysfunction, and localized angiogenesis/mitogenesis--and not just aggregation.
Santa-Cruz
Richard A
RA
Division of Cardiology, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC 27599-7075, USA.
Steinhubl
Steven R
SR
D001241:Aspirin / Q000494:pharmacology / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use*; D012008:Recurrence; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000494:pharmacology* / Q000627:therapeutic use*; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin