Chronic stable angina treatment clopidogrel: Difference between revisions
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{{Chronic stable angina}} | {{Chronic stable angina}} | ||
''' | |||
'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[John Fani Srour, M.D.]]; Jinhui Wu, M.D.; | |||
==Overview== | ==Overview== | ||
==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== | |||
*If [[aspirin]] use is contraindicated, [[clopidogrel]] is advisable. | *If [[aspirin]] use is contraindicated, [[clopidogrel]] is advisable. | ||
==Contra-indications== | |||
==Drug interactions== | |||
*Use of [[warfarin]] in conjunction with [[aspirin]] and/or [[clopidogrel]] is associated with an increased risk of bleeding and should be monitored closely. | *Use of [[warfarin]] in conjunction with [[aspirin]] and/or [[clopidogrel]] is associated with an increased risk of bleeding and should be monitored closely. | ||
==Adverse effects== | |||
==Supportive trial data== | |||
*In the Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events ('''CAPRIE''') trial, randomized comparison between [[clopidogrel]] and [[aspirin]] showed that clopidogrel resulted in 8.7% relative risk reduction of vascular death, [[ischemic stroke]], or [[myocardial infarction[[ among patients with established [[atherosclerotic]] vascular disease. | *In the Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events ('''CAPRIE''') trial, randomized comparison between [[clopidogrel]] and [[aspirin]] showed that clopidogrel resulted in 8.7% relative risk reduction of vascular death, [[ischemic stroke]], or [[myocardial infarction[[ among patients with established [[atherosclerotic]] vascular disease. | ||
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===Class IIa=== | ===Class IIa=== | ||
'''1.''' [[Clopidogrel]] when [[aspirin]] is absolutely contraindicated. ''(Level of Evidence: B)''}} | '''1.''' [[Clopidogrel]] when [[aspirin]] is absolutely contraindicated. ''(Level of Evidence: B)''}} | ||
==ESC Guidelines- Pharmacological therapy to improve prognosis in patients with stable angina (DO NOT EDIT)<ref name="pmid16735367">{{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/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367}}</ref>== | |||
{{cquote| | |||
===Class IIa=== | |||
'''1.''' [[Clopidogrel]] as an alternative antiplatelet agent in | |||
patients with stable angina who cannot take [[Chronic stable angina treatment aspirin|aspirin]] (e.g. aspirin allergic). ''(Level of Evidence: A)''}} | |||
==Vote on and Suggest Revisions to the Current Guidelines== | ==Vote on and Suggest Revisions to the Current Guidelines== | ||
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==Sources== | ==Sources== | ||
*Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{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/ehl001 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf]}} </ref> | *Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{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/ehl001 | pmc= |url=url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf]}} </ref> | ||
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <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> | *The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <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> | ||
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{{Reflist|2}} | {{Reflist|2}} | ||
[[Category: Disease state]] | [[Category:Ischemic heart diseases]] | ||
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[[Category: | [[Category:Disease state]] | ||
[[Category: | [[Category:Cardiology]] | ||
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[[Category:Intensive care medicine]] | |||
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Revision as of 23:56, 18 August 2011
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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. [4] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [5]; John Fani Srour, M.D.; Jinhui Wu, M.D.;
Overview
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
- If aspirin use is contraindicated, clopidogrel is advisable.
Contra-indications
Drug interactions
- Use of warfarin in conjunction with aspirin and/or clopidogrel is associated with an increased risk of bleeding and should be monitored closely.
Adverse effects
Supportive trial data
- In the Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial, randomized comparison between clopidogrel and aspirin showed that clopidogrel resulted in 8.7% relative risk reduction of vascular death, ischemic stroke, or [[myocardial infarction[[ among patients with established atherosclerotic vascular disease.
- In the latest Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial, dual anti platelet therapy with clopidogrel plus aspirin was not significantly more effective compared 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.
ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT)[1][2][3]
| “ |
Class I1. Use of warfarin in conjunction with aspirin and/or clopidogrel is associated with an increased risk of bleeding and should be monitored closely. (Level of Evidence: B) Class IIa1. Clopidogrel when aspirin is absolutely contraindicated. (Level of Evidence: B) |
” |
ESC Guidelines- Pharmacological therapy to improve prognosis in patients with stable angina (DO NOT EDIT)[4]
| “ |
Class IIa1. Clopidogrel as an alternative antiplatelet agent in patients with stable angina who cannot take aspirin (e.g. aspirin allergic). (Level of Evidence: A) |
” |
Vote on and Suggest Revisions to the Current Guidelines
Sources
- Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [4]
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [1]
- TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [2]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [3]
References
- ↑ 1.0 1.1 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. [1] PMID: 10351980
- ↑ 2.0 2.1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58.[2] PMID: 12515758
- ↑ 3.0 3.1 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.[3] PMID: 17998462
- ↑ 4.0 4.1 Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "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". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.