Clopidogrel in acute coronary syndromes

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ education articles:

From

Limit by

The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
You can use bmj.com to help you with your continuing medical education. Find out about CME/CPD credits for BMJ articles
Keep up to date with cardiology: Access the latest cardiovascular medicine resources from across BMJ Group.
Countdown to London 2012: BMJ Group's Olympics portal highlights latest Olympics and sports medicine-themed research, comment and learning

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Doson Chua, clinical pharmacotherapeutic specialist,
Andrew Ignaszewski, head, division of cardiology

¹St Paul’s Hospital, Department of Pharmacy, Vancouver, BC V6Z 1Y6, Canada

Correspondence to: D Chua dchua{at}providencehealth.bc.ca

Accepted 26 January 2009

Summary points

All patients presenting with acute coronary syndromes should be given a 300 mg loading dose of clopidogrel, then 75 mg daily
Patients not undergoing percutaneous coronary intervention should receive clopidogrel for nine to 12 months for non-ST elevation myocardial infarction and 14 days for ST elevation myocardial infarction
Patients given a bare metal stent should receive clopidogrel, in addition to aspirin, for at least one month and ideally for one year
Patients given a drug eluting stent should receive clopidogrel, in addition to aspirin, for at least one year
The duration of clopidogrel treatment must take into account the patient’s risk of bleeding

Clopidogrel is well established in the treatment of acute coronary syndromes and is ubiquitous in cardiology practice. Landmark studies have established the importance of clopidogrel in the treatment of non-ST and ST elevation myocardial infarction and in percutaneous coronary intervention by reducing death, reinfarction, and adverse cardiac events. Knowledge of the benefits, risks, and duration of clopidogrel treatment is important for clinicians caring for patients presenting with and recovering from acute coronary syndromes. This review examines the recent key trials of clopidogrel in the treatment of acute coronary syndromes, as well as current cardiac guidelines from several professional societies.

Sources and selection criteria

We reviewed the most recent guidelines from the American College of Cardiology, National Institute for Health and Clinical Excellence, European Society of Cardiology, and American College of Chest Physicians on the use of clopidogrel in myocardial infarction. The landmark trials discussed in the above guidelines were retrieved for further review. We also searched for subsequent publications in this area by the key authors of the landmark trials. We searched Medline, Cochrane Library, and Embase using the terms “clopidogrel”, “thienopyridine”, “myocardial infarction”, “acute coronary syndrome”, “percutaneous coronary intervention”, “coronary stent”, and “coronary artery disease” for any additional landmark studies, …