The role of clopidogrel in revascularized and nonrevascularized patients with acute coronary syndromes.
Despite many recent advancements in the treatment of coronary heart disease, it continues to be an important source of patient morbidity and mortality as well as a significant source of healthcare-related expenditures. Clopidogrel has become an integral part of the management of acute coronary syndromes (ACS) and, consequently, has become one of the world's best selling drugs. Numerous trials have demonstrated the clinical efficacy of clopidogrel in revascularized and nonrevascularized ACS including unstable angina as well as non-ST elevation and ST-elevation myocardial infarction. As a result of these trials, the use of clopidogrel has been incorporated into the American College of Cardiology/American Heart Association guidelines. Additionally, numerous analyses have proven clopidogrel to be highly cost effective. However, clopidogrel remains underutilized and guideline adherence remains inadequate despite the robust clinical data and guidelines. Institution of disease-management programs and quality-improvement initiatives appear to be an excellent strategy to promote guideline adherence and appropriate use of clopidogrel.
Collins
J Stewart
JS
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan 48109-0311, USA.
Gurm
Hitinder S
HS
D000208:Acute Disease; D000789:Angina, Unstable / Q000188:drug therapy / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000188:drug therapy* / Q000628:therapy; D003362:Cost-Benefit Analysis; D019983:Guideline Adherence; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000191:economics / Q000494:pharmacology* / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine