CLOPIDOGREL

WHO SHOULD HAVE IT AND FOR HOW LONG?

Clopidogrel alone:
Patients for whom Aspirin is indicated but where there is:

• Allergy to aspirin or NSAID
• Unacceptable risk of GI bleeding with Aspirin

Clopidogrel combined with Aspirin:

1. (i) Acute coronary syndrome (unstable angina or non-STEMI) patients (irrespective of whether angiography +/- subsequent stenting is performed) – for at least 6-9 months
   
   (ii) Post coronary stenting - for at least 9-12 months
   
   
2. Patients who have an ischaemic event (cardiac or neurological) while on Aspirin – indefinite.
   
   
3. High vascular risk patients
   
   - diabetic with vascular disease
   - previous CABG surgery
   - known severe vascular disease
   - recurrent ischaemic episodes (cerebral or cardiac) benefit demonstrated for up to one year.

NOTE:

• The addition of Clopidogrel to Aspirin increases the risk of serious bleeding by 2.7 to 3.7%
  
  
• Nearly all patients with the above indications qualify for approval of Clopidogrel under the Australian PBS schedule.
  
  
• Contraindications to Clopidogrel
  - hypersensitivity
  - active pathological bleeding such as peptic ulcer or intra-cranial haemorrhage

Dr Bernard Hockings
M.B.B.S.(WA). M.D.(WA), F.R.A.C.P.
Clinical Associate Professor of Medicine UWA

Reference :2002 European Society of Cardiology Guidelines .
Reviewed March 2004