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(Circulation. 2006;113:1638-1640.)
© 2006 American Heart Association, Inc.

Editorial

Is Clopidogrel Cardiovascular Medicine’s Double-Edged Sword?

Anthony A. Bavry, MD, MPH; A. Michael Lincoff, MD

From the Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.

Reprint requests to A. Michael Lincoff, MD, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195. E-mail lincofa@ccf.org

Key Words: Editorials • angina • anticoagulants • stents • thrombosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Antiplatelet therapy with aspirin has been unequivocally demonstrated to reduce the risk of ischemic complications across a broad spectrum of patients with vascular disease.¹ This agent is also an important pharmacological adjunct to percutaneous and surgical coronary revascularization procedures. Administration of aspirin after coronary bypass graft operations had been the standard of care for many years, although early experience suggested that this agent would increase hemorrhagic complications if administered before surgery.² However, subsequent evidence showed that preoperative aspirin improves survival without an appreciable increase in surgical bleeding.³ More recently, concerns regarding surgical bleeding risk have resurfaced with the introduction into clinical practice of a newer class of platelet inhibitors: the thienopyridines, ticlopidine and clopidogrel.

Article p 1667

Thienopyridines interfere with platelet activation by selectively and irreversibly blocking a subunit of the adenosine diphosphate receptor. This provides an antiplatelet effect that is additive to the inhibition of the thromboxane A₂ pathway by aspirin. The clinical benefit derived from the combination of aspirin and a thienopyridine first became apparent with trials demonstrating the efficacy of these agents in preventing subacute thrombosis after coronary stenting.⁴ Subsequently, large-scale clinical studies showed that long-term therapy (9 to 12 months) with aspirin and clopidogrel reduces ischemic complications compared with aspirin alone among patients with acute coronary syndromes⁵ or after percutaneous coronary revascularization.⁶ In the population of patients with acute coronary syndromes, dual antiplatelet therapy begins to reduce adverse outcomes as early as 2 hours after administration, and the magnitude of benefit expands over the following 9 . . . [Full Text of this Article]

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