Chronic stable angina treatment clopidogrel: Difference between revisions
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/* ESC Guidelines- Pharmacological therapy to improve prognosis in patients with stable angina (DO NOT EDIT){{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable ang... |
Aysha Aslam (talk | contribs) /* 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines and the 1999 ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al... |
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Thienopyridines, such as [[clopidogrel]] and [[ticlopidine]], selectively inhibit ADP-induced platelet aggregation and are used as an alternative to [[aspirin]] in patients with significant risk of arterial thrombosis. | Thienopyridines, such as [[clopidogrel]] and [[ticlopidine]], selectively inhibit ADP-induced platelet aggregation and are used as an alternative to [[aspirin]] in patients with significant risk of arterial thrombosis. | ||
==Mechanisms of Benefit== | ==Clopidogrel== | ||
===Mechanisms of Benefit=== | |||
*[[Clopidogrel]] is a thienopyridine derivative which prevents adenosine diphosphate–mediated activation of platelets by selectively and irreversibly inhibiting the binding of [[adenosine diphosphate]] to its platelet receptors and thereby, blocking adenosine diphosphate–dependent activation of the [[glycoprotein IIb/IIIa]] complex. | *[[Clopidogrel]] is a thienopyridine derivative which prevents adenosine diphosphate–mediated activation of platelets by selectively and irreversibly inhibiting the binding of [[adenosine diphosphate]] to its platelet receptors and thereby, blocking adenosine diphosphate–dependent activation of the [[glycoprotein IIb/IIIa]] complex. | ||
*[[Ticlopidine]], another thienopyridine derivative, decreases platelet function in patients with stable angina but, unlike [[aspirin]], has not been shown to decrease adverse cardiovascular events. | *[[Ticlopidine]], another thienopyridine derivative, decreases platelet function in patients with stable angina but, unlike [[aspirin]], has not been shown to decrease adverse cardiovascular events. | ||
==Indication== | ===Indication=== | ||
[[Clopidogrel]] is used in patients with contraindication to aspirin or [[aspirin]] intolerance. | [[Clopidogrel]] is used in patients with contraindication to aspirin or [[aspirin]] intolerance. | ||
==Drug Interactions== | ===Drug Interactions=== | ||
*Use of [[warfarin]] in conjunction with [[aspirin]] and/or [[clopidogrel]] is associated with an increased risk of bleeding and therefore, close monitoring is required. | *Use of [[warfarin]] in conjunction with [[aspirin]] and/or [[clopidogrel]] is associated with an increased risk of bleeding and therefore, close monitoring is required. | ||
| Line 22: | Line 23: | ||
*Clopidogrel is metabolized via CYP-3A4, hence drugs that inhibit ([[erythromycin]]) or induce ([[rifampicin]]) CYP-34A alter the plasma levels of [[clopidogrel]].<ref name="pmid12515739">Lau WC, Waskell LA, Watkins PB, Neer CJ, Horowitz K, Hopp AS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515739 Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation: a new drug-drug interaction.] ''Circulation'' 107 (1):32-7. PMID: [http://pubmed.gov/12515739 12515739]</ref> | *Clopidogrel is metabolized via CYP-3A4, hence drugs that inhibit ([[erythromycin]]) or induce ([[rifampicin]]) CYP-34A alter the plasma levels of [[clopidogrel]].<ref name="pmid12515739">Lau WC, Waskell LA, Watkins PB, Neer CJ, Horowitz K, Hopp AS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515739 Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation: a new drug-drug interaction.] ''Circulation'' 107 (1):32-7. PMID: [http://pubmed.gov/12515739 12515739]</ref> | ||
==Adverse Effects== | ===Adverse Effects=== | ||
*Clopidogrel: | *Clopidogrel: | ||
:*Gastrointestinal bleed | :*Gastrointestinal bleed | ||
| Line 31: | Line 32: | ||
:*[[Thrombocytopenia]] | :*[[Thrombocytopenia]] | ||
==Supportive Trial Data== | ===Supportive Trial Data=== | ||
*The ''CAPRIE'' trial, a randomized blinded study of 19,185 patients with [[atherosclerotic|atherosclerotic vascular disease]] assessing the efficacy of clopidogrel versus aspirin therapies, showed a modest difference in the effectiveness between [[clopidogrel]] and [[aspirin]]. There was a relative risks reduction of 8.7% in favor of [[clopidogrel]] therapy among patients with established [[atherosclerotic]] vascular disease in reducing the combined risk of [[ischemic stroke]], [[myocardial infarction]] and vascular death.<ref name="pmid8918275"> (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8918275 A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee.] ''Lancet'' 348 (9038):1329-39. PMID: [http://pubmed.gov/8918275 8918275]</ref> | *The ''CAPRIE'' trial, a randomized blinded study of 19,185 patients with [[atherosclerotic|atherosclerotic vascular disease]] assessing the efficacy of clopidogrel versus aspirin therapies, showed a modest difference in the effectiveness between [[clopidogrel]] and [[aspirin]]. There was a relative risks reduction of 8.7% in favor of [[clopidogrel]] therapy among patients with established [[atherosclerotic]] vascular disease in reducing the combined risk of [[ischemic stroke]], [[myocardial infarction]] and vascular death.<ref name="pmid8918275"> (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8918275 A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee.] ''Lancet'' 348 (9038):1329-39. PMID: [http://pubmed.gov/8918275 8918275]</ref> | ||
| Line 38: | Line 39: | ||
*The ''CHARISMA'' trial, a randomized placebo controlled study involving 2,163 patients, reported dual anti platelet therapy with [[clopidogrel]] plus [[aspirin]] was not significantly effective in comparison to aspirin alone in reducing the rate of [[myocardial infarction]], [[stroke]], or cardiovascular death in patients with established vascular disease or at high risk for developing vascular disease.<ref name="pmid21205234">Hankey GJ, Johnston SC, Easton JD, Hacke W, Mas JL, Brennan D et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21205234 Effect of clopidogrel plus ASA vs. ASA early after TIA and ischaemic stroke: a substudy of the CHARISMA trial.] ''Int J Stroke'' 6 (1):3-9. [http://dx.doi.org/10.1111/j.1747-4949.2010.00535.x DOI:10.1111/j.1747-4949.2010.00535.x] PMID: [http://pubmed.gov/21205234 21205234]</ref> | *The ''CHARISMA'' trial, a randomized placebo controlled study involving 2,163 patients, reported dual anti platelet therapy with [[clopidogrel]] plus [[aspirin]] was not significantly effective in comparison to aspirin alone in reducing the rate of [[myocardial infarction]], [[stroke]], or cardiovascular death in patients with established vascular disease or at high risk for developing vascular disease.<ref name="pmid21205234">Hankey GJ, Johnston SC, Easton JD, Hacke W, Mas JL, Brennan D et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21205234 Effect of clopidogrel plus ASA vs. ASA early after TIA and ischaemic stroke: a substudy of the CHARISMA trial.] ''Int J Stroke'' 6 (1):3-9. [http://dx.doi.org/10.1111/j.1747-4949.2010.00535.x DOI:10.1111/j.1747-4949.2010.00535.x] PMID: [http://pubmed.gov/21205234 21205234]</ref> | ||
== | ==2012 Chronic Angina Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT))<ref name="pmid23166210">{{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2012 | volume= 126 | issue= 25 | pages= 3097-137 | pmid=23166210 | doi=10.1161/CIR.0b013e3182776f83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23166210 }} </ref>== | ||
===Clopidogrel (DO NOT EDIT)<ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref><ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref>=== | ===Clopidogrel (DO NOT EDIT))<ref name="pmid23166210">{{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2012 | volume= 126 | issue= 25 | pages= 3097-137 | pmid=23166210 | doi=10.1161/CIR.0b013e3182776f83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23166210 }} </ref><ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref><ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref>=== | ||
{| class="wikitable" | {| class="wikitable" | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Treatment with clopidogrel is reasonable when aspirin is contraindicated in patients with SIHD ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | ||
|} | |} | ||
{| class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class | | colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | ||
|- | |- | ||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' | | bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Treatment with aspirin 75 to 162 mg daily and clopidogrel 75 mg daily might be reasonable in certain high-risk patients with SIHD''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | ||
|} | |} | ||
Latest revision as of 18:52, 31 October 2016
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Chronic stable angina Microchapters | ||
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Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Diagnosis | ||
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Alternative Therapies for Refractory Angina | ||
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Discharge Care | ||
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Guidelines for Asymptomatic Patients | ||
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Case Studies | ||
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Chronic stable angina treatment clopidogrel On the Web | ||
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to Hospitals Treating Chronic stable angina treatment clopidogrel | ||
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Risk calculators and risk factors for Chronic stable angina treatment clopidogrel | ||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [4]; John Fani Srour, M.D.; Jinhui Wu, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Thienopyridines, such as clopidogrel and ticlopidine, selectively inhibit ADP-induced platelet aggregation and are used as an alternative to aspirin in patients with significant risk of arterial thrombosis.
Clopidogrel
Mechanisms of Benefit
- Clopidogrel is a thienopyridine derivative which prevents adenosine diphosphate–mediated activation of platelets by selectively and irreversibly inhibiting the binding of adenosine diphosphate to its platelet receptors and thereby, blocking adenosine diphosphate–dependent activation of the glycoprotein IIb/IIIa complex.
- Ticlopidine, another thienopyridine derivative, decreases platelet function in patients with stable angina but, unlike aspirin, has not been shown to decrease adverse cardiovascular events.
Indication
Clopidogrel is used in patients with contraindication to aspirin or aspirin intolerance.
Drug Interactions
- Use of warfarin in conjunction with aspirin and/or clopidogrel is associated with an increased risk of bleeding and therefore, close monitoring is required.
- Atorvastatin via ADP mediated platelet activation inhibits clopidogrel.[1] However, this inhibition is not observed with low dose atorvastatin (10mg).[2]
- Clopidogrel is metabolized via CYP-3A4, hence drugs that inhibit (erythromycin) or induce (rifampicin) CYP-34A alter the plasma levels of clopidogrel.[1]
Adverse Effects
- Clopidogrel:
- Gastrointestinal bleed
- Active bleeding
- Ticlopidine:
Supportive Trial Data
- The CAPRIE trial, a randomized blinded study of 19,185 patients with atherosclerotic vascular disease assessing the efficacy of clopidogrel versus aspirin therapies, showed a modest difference in the effectiveness between clopidogrel and aspirin. There was a relative risks reduction of 8.7% in favor of clopidogrel therapy among patients with established atherosclerotic vascular disease in reducing the combined risk of ischemic stroke, myocardial infarction and vascular death.[3]
- The CURE trial, a randomized placebo controlled studying involving 12,562 who received either clopidogrel or placebo in addition to aspirin for 3-12 months after the first 24 hours of onset of symptoms, demonstrated the efficacy and safety of adding clopidogrel (a loading dose of 300 mg, followed by 75 mg daily) to aspirin in the long-term management of patients with acute coronary syndromes without ST-segment elevation.[4]
- The CHARISMA trial, a randomized placebo controlled study involving 2,163 patients, reported dual anti platelet therapy with clopidogrel plus aspirin was not significantly effective in comparison to aspirin alone in reducing the rate of myocardial infarction, stroke, or cardiovascular death in patients with established vascular disease or at high risk for developing vascular disease.[5]
2012 Chronic Angina Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT))[6]
Clopidogrel (DO NOT EDIT))[6][7][8]
| Class I |
| "1. Treatment with clopidogrel is reasonable when aspirin is contraindicated in patients with SIHD (Level of Evidence: B) " |
| Class IIb |
| "1. Treatment with aspirin 75 to 162 mg daily and clopidogrel 75 mg daily might be reasonable in certain high-risk patients with SIHD(Level of Evidence: B) " |
ESC Guidelines- Pharmacological Therapy to Improve Prognosis in Patients with Stable Angina (DO NOT EDIT)[9]
Clopidogrel (DO NOT EDIT)[9]
| Class IIa |
| "1. Clopidogrel as an alternative antiplatelet agent inpatients with stable angina who cannot take aspirin (e.g. aspirin allergic). (Level of Evidence: A) " |
Concomitant use of Proton Pump Inhibitors and Thienopyridines
ACC/AHA Guidelines- ACCF/ACG/AHA 2010 Expert Consensus Document on the Concomitant Use of Proton Pump Inhibitors and Thienopyridines[10] (DO NOT EDIT)
| “ |
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References
- ↑ 1.0 1.1 Lau WC, Waskell LA, Watkins PB, Neer CJ, Horowitz K, Hopp AS et al. (2003) Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation: a new drug-drug interaction. Circulation 107 (1):32-7. PMID: 12515739
- ↑ Mitsios JV, Papathanasiou AI, Rodis FI, Elisaf M, Goudevenos JA, Tselepis AD (2004) Atorvastatin does not affect the antiplatelet potency of clopidogrel when it is administered concomitantly for 5 weeks in patients with acute coronary syndromes. Circulation 109 (11):1335-8. DOI:10.1161/01.CIR.0000124581.18191.15 PMID: 15023882
- ↑ (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 348 (9038):1329-39. PMID: 8918275
- ↑ Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK et al. (2001) Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 345 (7):494-502. DOI:10.1056/NEJMoa010746 PMID: 11519503
- ↑ Hankey GJ, Johnston SC, Easton JD, Hacke W, Mas JL, Brennan D et al. (2011) Effect of clopidogrel plus ASA vs. ASA early after TIA and ischaemic stroke: a substudy of the CHARISMA trial. Int J Stroke 6 (1):3-9. DOI:10.1111/j.1747-4949.2010.00535.x PMID: 21205234
- ↑ 6.0 6.1 Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP; et al. (2012). "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 126 (25): 3097–137. doi:10.1161/CIR.0b013e3182776f83. PMID 23166210.
- ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[1] PMID: 17998462
- ↑ Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. [2] PMID: 10351980
- ↑ 9.0 9.1 {{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj
- ↑ Abraham NS, Hlatky MA, Antman EM, Bhatt DL, Bjorkman DJ, Clark CB; et al. (2010). "ACCF/ACG/AHA 2010 Expert Consensus Document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents". Circulation. 122 (24): 2619–33. doi:10.1161/CIR.0b013e318202f701. PMID 21060077.