When one discusses pharmacogenetics in cardiology practice, it is almost obligatory to discuss clopidogrel. Clopidogrel is an antiplatelet used for acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) with stenting, and as secondary stroke prevention in patients with aspirin allergy, among other indications. Clopidogrel is a prodrug that must be metabolized through the cytoch...

 Clopidogrel is recommended as part of dual antiplatelet therapy (DAT) for clot prevention in patients with acute coronary syndrome (ACS). Clopidogrel is a prodrug that requires activation by CYP2C19 enzymes in the liver. It is expected that 16% to 50% of clopidogrel-treated patients who have ACS may not fully benefit from the protective effect of clopidogrel, potentially remaining at an incre...

OBJECTIVES The aim of the present study was to compare clopidogrel and ticlopidine after coronary stenting with regard to cardiovascular death during long-term follow-up. BACKGROUND Randomized trials comparing clopidogrel and ticlopidine with a restricted use of intravenous glycoprotein IIb/IIIa inhibition have reported a trend toward a higher incidence of thrombotic stent occlusion with clop...

OBJECTIVE To evaluate whether smoking status is associated with the efficacy of antiplatelet treatment in the prevention of cardiovascular events. DESIGN Systematic review, meta-analysis, and indirect comparisons. DATA SOURCES Medline (1966 to present) and Embase (1974 to present), with supplementary searches in databases of abstracts from major cardiology conferences, the Cumulative Index ...

Background—Studies suggest that extended clopidogrel use after drug-eluting stent (DES) implantation may decrease the risk of myocardial infarction (MI) and death. Little is known about the competing risk of bleeding from clopidogrel in “real world” clinical practice. Methods and Results—We studied 7689 patients undergoing drug-eluting stent implantation enrolled in the HMO Research Network-Ste...

OBJECTIVES We sought to evaluate the long-term cost-effectiveness of clopidogrel for up to one year after an acute coronary syndrome (ACS) without ST-segment elevation. BACKGROUND The efficacy of platelet inhibition with clopidogrel for up to one year after ACS was demonstrated in the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial, a randomized trial of 12,562 patient...

Clopidogrel has been reported to be safe and effective in reducing vascular events. Nevertheless, there is growing evidence that clopidogrel may cause thrombotic thrombocytopenic purpura/haemolytic uraemic syndrome (TTP/HUS). This association has been debated, since in several cases alternative causes could not be excluded. Two new cases of TTP/HUS associated with clopidogrel are reported here....

The cornerstone in clinical evidence of the relative efficacy of thienopyridines (clopidogrel, ticlopidine) versus aspirin in the secondary prevention of vascular disease is the Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events trial. This trial showed a modest benefit in the reduction of vascular events by clopidogrel. The results differed according to qualifying disorder: myo...

INTRODUCTION Clopidogrel ineffectiveness is a serious problem in antiplatelet therapy. Many factors may contribute to this phenomenon. One of them is clopidogrel drug-drug interaction with CYP2C19 and CYP3A4 enzyme inhibitors. The main goal of this descriptive study was to assess the prevalence of cases of clopidogrel-drug interactions in the primary health care physicians' practices. MATERIA...

BACKGROUND A recent report suggested that carriers of the Q allele of the PON1 Q192R polymorphism had decreased biotransformation of clopidogrel into its active metabolite and decreased efficacy of clopidogrel in preventing cardiovascular events. Furthermore, PON1 has been reported to have a central role in the antioxidant function of high-density lipoprotein, and the Q192R polymorphism has bee...