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Role of Clopidogrel in Atherosclerotic Vascular Disease
1. The role of Clopidogrel
in
Atherosclerosis Vascular
Disease
Ahmed Taha Abdelwahed, MD, EHRA-Certified
Lecturer of Cardiology
Department of Cardiology, Faculty of Medicine,
Zagazig University, Egypt;
Heart Center, Department of Cardiology, Tampere University Hospital, and School of
Medicine, Tampere University- Finland
2. Arteriosclerotic Vascular Disease or ASVD
Atherosclerosis : the condition in which an artery wall thickens as the result of a build-up of fatty materials
such as cholesterol affecting arterial blood vessels,
A chronic inflammatory response in the walls of arteries, due to the accumulation of macrophage white
blood cells and promoted by Low-density lipoproteins without adequate removal of fats and cholesterol
from the macrophages by functional high-density lipoproteins.
6. Background
1. Antiplatelet therapy has remained the cornerstone of treatment for patients with
ACS :” Platelet adhesion, activation, and aggregation after plaque rupture or
erosion are the major determinants of arterial thrombosis leading to ACS”
2. Anti-platelet therapy is vital
3. Multiple platelet-signaling pathways are involved in thrombus formation and are
potential targets for therapies.
4. Dual antiplatelet therapy with a combination of aspirin and either P2Y12-receptor
inhibitors should be the treatment of choice in patients with ACS.
10. Metabolism of P2Y12 Receptor
Antagonists
Adapted from: Schomig A. NEJM. 2009;361(11):1108-1111.
Effient (Prasugrel) Product Monograph March 11, 2011 version.
Brilinta (Ticagrelor) Product Monograph May 26, 2011 version.
Plavix (Clopidogrel) Product Monograph May 9, 2011 version.
11. Clopidogrel
is a pro-drug, with hepatic metabolism (2 hours) required to form the highly reactive and
short-lived compound responsible for its activity .
The requirement for cytochrome P450 family of enzymes for metabolism (activation)
27. CHARISMA study
The Clopidogrel for High Atherothrombotic
Risk and Ischemic Stabilization,
Management, and Avoidance
Clinical trials
28.
29. TALOS AMI study
TicAgrelor Versus CLOpidogrel in
Stabilized Patients With Acute Myocardial
Infarction
De-escalation of DAPT therapy
What’s new in 2021
63. Conclusion
Prasugrel and ticagrelor is more efficacious in preventing ischemic events in patients
with ACS undergoing PCI, but with increased bleeding complications.
Dual antiplatelet treatment has only been efficacious in ACS and post-PCI patients.
Newer thienopyridines did not show advantages over and above those of ticlopidine or
clopidogrel as to reduction of stroke.
De-escalation of Dual Antiplatelet Therapy Appears Safe and Effective, either
from ticagrelor or prasugrel to Clopidogrel.
genotype-guided DAPT de-escalation may be favored. Moreover, clopidogrel may be
considered the first choice of antiplatelet therapy in elderly patients with ACS.
patients with stroke or very high-risk TIA, intensive DAPT with aspirin plus clopidogrel
should be administered for 21–28 days after the acute event, followed by less intensive
treatment for up to 90 days, to minimize the risk of bleeding complications; clopidogrel
is potentially more effective than aspirin as antiplatelet monotherapy.
In patients with symptomatic PAD, or those who have undergone peripheral
revascularization, clopidogrel is the preferred agent