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

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, …