title: Switching from generic to brand clopidogrel in male patients after ST-elevated myocardial infarction.
abstract: OBJECTIVE
  To detect residual platelet aggregation following the switch from generic (GC) to brand clopidogrel (BC) in male patients after ST-elevated myocardial infarction (STEMI).
  
  
  METHODS
  The study was designed as an open-label, prospective cohort trial. Thirty-three male STEMI patients were enrolled. All patients received dual antiplatelet therapy with aspirin (100 mg/daily) and one of six GC at a daily dose of 75 mg. After 2 weeks, all patients were switched to BC. Adrenaline- and adenosine diphosphate (ADP)-induced platelet aggregation was assessed twice: on day 14 (before the switch) and on day 21 (after 1 week of BC therapy).
  
  
  RESULTS
  Adrenaline-induced platelet aggregation did not differ among clopidogrel formulations. In contrast, residual 5 µM ADP-induced platelet aggregation after BC differs from GC by 14% (28.0 ± 2.5 vs. 23.9 ± 2.1%; p = 0.03). When 20 µM ADP was used as agonist, the difference was smaller (36.2 ± 2.9 vs. 34.6 ± 2.8%) but still significant (p = 0.04) favoring BC.
  
  
  CONCLUSIONS
  After 2 weeks of therapy, switching from GC to BC was associated with a mild but significant reduction in ADP-induced platelet aggregation in male post-STEMI patients. The observed differences between GC and BC should be confirmed in a larger randomized study, but may represent a risk in underdeveloped countries, where GC therapy is mandatory for post-MI inpatients.
authors.affiliation: HeartDrug™ Research Laboratories, Johns Hopkins University, Towson, Md., USA.
authors.forename: Vitaliy V
authors.initials: VV
authors.lastname: Syvolap
authors.forename: Ludmila V
authors.initials: LV
authors.lastname: Franskavichene
authors.forename: Elena Z
authors.initials: EZ
authors.lastname: Golukhova
authors.forename: Victor L
authors.initials: VL
authors.lastname: Serebruany
mesh_terms: D000244:Adenosine Diphosphate / Q000494:pharmacology; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D016568:Drugs, Generic / Q000627:therapeutic use*; D004837:Epinephrine / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D016568:Drugs, Generic; D010975:Platelet Aggregation Inhibitors; D000244:Adenosine Diphosphate; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; D004837:Epinephrine