A Randomized Comparison of Clopidogrel and Aspirin Versus Ticlopidine and Aspirin After the Placement of Coronary-Artery Stents

Abstract

After the placement of coronary-artery stents in unselected patients, antiplatelet therapy with aspirin and clopidogrel seems to be comparably safe and effective as aspirin and ticlopidine. Noncardiac events were significantly reduced with clopidogrel.

Pharmacoeconomic Analysis of Clopidogrel in Secondary Prevention of Coronary Artery Disease

“…Tables 1 and 2 summarize the results of these studies. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] More recently, the results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) clinical trial have called into question the value of PCI in high-risk patients with confirmed CAD. This large, 50-center trial with 4.6 years of median follow-up per patient may result in a reduced use of coronary stents for secondary prevention, one of the major indications for the use of clopidogrel.…”

“…6 The combined use of aspirin and clopidogrel, however, has been demonstrated in many studies to increase the risk of bleeding (Tables 1 and 2). [1][2][3][4][5][6][7][8][9][10][11][12][13][14] In addition, because clopidogrel requires a fairly long time to achieve peak response (3 to 7 days), 15 more recent studies have continued to evaluate the increase in loading doses of clopidogrel, from 300 mg to 600 mg to 900 mg, in an attempt to achieve maximal effects faster. 13,16,17 However, the increased loading doses also increase the risk of bleeding.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] Some clinicians recommend that patients use clopidogrel plus aspirin therapy for life to theoretically prevent the risk of future CV events. The risk versus benefit ratio of such prolonged use is unknown.…”

Cangrelor for the management and prevention of arterial thrombosis

“…The thienopyridines ticlopidine and clopidogrel belong to another class of drugs that block ADP-mediated platelet activation by irreversibly inhibiting the P2Y 12 receptors; these were shown to have superior efficacy, alone or combined with aspirin, than aspirin alone or aspirin plus anticoagulant therapy in preventing major cardiovascular complications [19]. The use of clopidogrel has predominated over ticlopidine due to its fewer adverse effects [20].…”

CLopidogrel Trial in Patients With Elective Percutaneous Coronary Intervention for Stable ANgina and Old Myocardial Infarction (CLEAN)

“…Although the number of elective PCI procedures performed in Japan is increasing, there have been no studies to date that have provided clinical evidence for the efficacy and safety of antiplatelet drugs in these patient settings. Outside Japan, clopidogrel is widely used as an antiplatelet drug in patients with CAD who have undergone PCI since 3 randomized controlled studies [10][11][12] and several registries and meta-analyses [13][14][15][16][17][18] suggest that clopidogrel seems to be at least as effective as ticlopidine, and clopidogrel has fewer adverse drug reactions and is better tolerated compared to ticlopidine. In fact, a loading dose of 300 mg of clopidogrel followed by a maintenance dose of 75 mg once daily is used in this setting 19,20) and the same regimen will also be applied to Japanese patients for whom PCI is planned, regardless of whether the PCI is elective or urgent.…”