How should clopidogrel be used? At least 4 points need to be known!

*For medical professionals only

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01 Acute coronary syndrome (ACS)-related diseases

1.1

Adult (domestic usage)

▎1.1.1 Indications

Non-ST-segment elevation acute coronary syndrome (including unstable angina or non-Q-wave myocardial infarction), including patients with stent placement after percutaneous coronary intervention, in combination with aspirin.

It is used in patients with ST-segment elevation acute coronary syndrome, in combination with aspirin, and can be used in combination with thrombolytic therapy.

▎1.1.2 Dosage

Recommended dose: 75 mg once daily.

Patients with non-ST-segment elevation acute coronary syndrome (unstable angina/non-Q-wave myocardial infarction): starting with a single loading dose (a dose with a steady-state level of blood concentration at the time of first administration) 300 mg (combined aspirin 75 mg to 325 mg/day), followed by 75 mg once daily for continuous administration.

ST-segment elevation acute myocardial infarction: clopidogrel should be started at a loading dose, followed by 75 mg once daily, with aspirin, with or without thrombolytics.

1.2

Adults (foreign usage)

▎1.2.1 Indications

Should be given in combination with aspirin to reduce the incidence of myocardial infarction (MI) and stroke in patients with non-ST-segment elevation acute coronary syndrome (unstable angina/non-ST-segment elevation myocardial infarction), including patients who will be on medication and require coronary artery revascularization.

It should be given in combination with aspirin to reduce the incidence of myocardial infarction and stroke in patients with acute ST-segment elevation myocardial infarction (STEMI).

▎1.2.2 Dosage

For patients who need to develop antiplatelet effects within a few hours, clopidogrel should be started at a loaded dose of 300 mg orally as a single dose, followed by 75 mg once daily and continued.

Initiation of clopidogrel without taking a loading dose delays the antiplatelet effect for several days[2].

02 Recent myocardial infarction, recent ischemic stroke or confirmed peripheral arterial disease

2.1

▎2.1.1 Indications

Indicated for patients with recent myocardial infarction (time in recent days to less than 35 days), in patients with recent ischemic stroke (last 7 days to less than 6 months), or in patients with confirmed peripheral arterial disease.

▎2.1.2 Dosage

The recommended dose is 75 mg/day[1].

2.2

▎2.2.1 Indications

Clopidogrel can be used to reduce the incidence of MI and stroke in patients with confirmed peripheral arterial disease or a history of recent myocardial infarction (MI) or recent stroke.

▎2.2.2 Dosage

75 mg once daily without the need to reach the first loading dose[2].

03 Medication for special populations

3.1

Adults (renal impairment)

Clopidogrel 75 mg once daily, after repeated administration, patients with severe renal impairment (creatinine clearance 5-15 ml / min) had lower inhibition of platelet aggregation induced by adenosine diphosphate (ADP) compared with healthy subjects (25%), but the bleeding time was prolonged after taking the drug. Clinically well tolerated in all patients [1].

3.2

Adults (liver damage)

In patients with severe liver impairment, after 75 mg of oral clopidogrel daily for 10 days, the inhibitory effect on ADP-induced platelet aggregation was similar to that observed in healthy subjects. The mean bleeding time length was also similar in both groups [1].

3.3

Children's Usage

Efficacy and safety in pediatric patients have not been established [2].

3.4

Elderly usage

Dose adjustment is not required in older patients [2].

3.5

Medication during pregnancy

No significant birth defects or risk of miscarriage associated with the drug were found. The use of clopidogrel during childbirth or during childbirth increases the risk of maternal bleeding and bleeding. If possible, discontinue clopidogrel 5-7 days before delivery or spinal block.

3.6

Medication during lactation

There are no data on the presence of clopidogrel in human milk or the effect on milk production.

Studies in rats have shown that clopidogrel and/ or its metabolites are present in breast milk. When the drug is present in animal milk, the drug is likely to be present in human milk.

04 Discontinue clopidogrel

Discontinuation of clopidogrel increases the risk of cardiovascular events. If clopidogrel must be temporarily discontinued (e.g., surgery for bleeding or with significant bleeding risk), restart the medication as soon as possible.

bibliography:

[1] Drug information: Clopidogrel bisulfate tablets, National Pharmaceutical Standard J20150111, last revised on 2015/08/18.

[2] Product Information: clopidogrel bisulfate oral tablets. Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership (FDA), Bridgewater, NJ, 2019.

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Source: Clinical Decision Assistant

Author: Jordan

Editor-in-charge: Zheng Huaju

Proofreader: Zang Hengjia

Plate making: Xue Jiao