title: Role of clopidogrel in unstable angina and non-ST-segment elevation myocardial infarction: from literature and guidelines to practice.
abstract: Clinical trials are the backbone of treatment paradigm shifts and guideline development. In terms of acute coronary syndromes, the American College of Cardiology and the American Heart Association (ACC-AHA) have developed extensive guidelines to assist the practitioner in the appropriate use of drugs including antiischemic, anticoagulant, and antiplatelet agents. Clopidogrel, an adenosine 5'-diphosphate antagonist, is one such drug. Unfortunately, consensus guidelines are limited by the design of the clinical trials they reference. Clopidogrel trials have examined various outcomes in patients for a limited time frame, making longer term use of the drug difficult to justify. An ongoing study, estimated to be completed in 2005, is evaluating the long-term use of clopidogrel in high-risk patients. Aspirin, however, has become a lifelong therapy for many patients, based on clinical trials and medical experience. Patient-specific risk factors, the drugs' safety profiles, and costs, in addition to the ACC-AHA guidelines, must all be considered by clinicians when selecting the appropriate agent and its duration of use.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, University of South Carolina, Columbia, South Carolina 29208, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Kerr
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Oppelt
authors.forename: Randall C
authors.initials: RC
authors.lastname: Rowen
mesh_terms: D000789:Angina, Unstable / Q000188:drug therapy*; D001241:Aspirin / Q000627:therapeutic use*; D000077144:Clopidogrel; D003327:Coronary Disease / Q000188:drug therapy* / Q000503:physiopathology; D003362:Cost-Benefit Analysis; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin