• Basic Info
• Top Questions
• Clinical Info
• Interactions

Uses

Prevention of Cardiovascular or Cerebrovascular Events

Reduction of the risk of cardiovascular or cerebrovascular events (new MI, new ischemic stroke, and vascular death) in patients with a history of recent MI, recent ischemic stroke, or established peripheral arterial disease. Recommended as an alternative to aspirin in those with aspirin allergy.

Clopidogrel monotherapy or aspirin in combination with dipyridamole may be preferable to aspirin monotherapy for secondary prevention of stroke based on a somewhat greater absolute risk reduction for stroke; weigh benefit against additional costs of therapy.

In patients with peripheral arterial disease, clopidogrel recommended over ticlopidine or no antiplatelet therapy for prevention of death and disability from stroke or MI.

Use of aspirin rather than clopidogrel is suggested by American College of Chest Physicians (ACCP) because of lower cost and modest additional benefit of clopidogrel over aspirin.

Unstable Angina or Non-ST-Segment Elevation MI

Used in combination with aspirin for reduction of the risk of cardiovascular or cerebrovascular events in patients with unstable angina or non-ST-segment elevation (NSTE) MI (acute coronary syndromes [ACSs]) in patients who are managed medically or with coronary intervention (e.g., PCI with or without coronary artery stenting, CABG).

Long-term use recommended by ACCP as an alternative to aspirin in patients with unstable angina or NSTE MI, including those undergoing CABG, who are allergic to aspirin†.

Recommended by ACC/AHA and other clinicians as an adjunct to acute therapy with heparin and aspirin in patients with NSTE ACS who are managed medically and in those undergoing PCI who are not at high risk for bleeding.

Begin treatment promptly upon diagnosis and continue for ≥1 month, ideally ≤1 year in patients who are not at high risk for bleeding.

Balance potential benefit of pretreatment with clopidogrel in patients undergoing PCI against increased risk of bleeding should emergency CABG be needed. ACCP and ACC/AHA suggest delaying treatment initiation until coronary anatomy favoring CABG is ruled out, if diagnostic assessment is performed rapidly. If diagnostic catheterization will be delayed (>24 hours after admission) or CABG is scheduled >5 days after coronary angiography, ACCP recommends initiation of therapy immediately. Temporarily discontinue therapy 5–7 days prior to CABG and reinitiate therapy in conjunction with aspirin after the procedure.

In patients undergoing PCI with an absolute contraindication to aspirin†, pretreatment with clopidogrel and/or a GP IIb/IIIa-receptor inhibitor is reasonable. (See General under Dosage and Administration.)

Following implantation of a bare-metal coronary artery stent in patients at low risk for bleeding, ACC/AHA and other clinicians currently recommend use in combination with aspirin for ≥1 month, ideally for ≤1 year.

In patients at low atherosclerotic risk, ACCP recommends combination therapy with aspirin for ≥2 weeks after implantation of a bare-metal stent.

Following bare-metal stent placement in patients at high risk for bleeding, ACC/ AHA recommend short-term clopidogrel monotherapy.

Prolonged dual-drug therapy (≥12 months) with aspirin recommended in patients with drug-eluting stents (DES) who are not at high risk of bleeding. (See Thrombosis Associated with Drug-eluting Stents under Cautions.)

ST-Segment Elevation MI

Used in combination with aspirin and other antithrombotic therapy for reduction of the rate of ischemic cardiovascular and cerebrovascular events in patients with ST-segment elevation MI.

Suggested as adjunct to thrombolytic therapy in patients with acute ST-segment elevation MI who are allergic to aspirin or in whom aspirin is otherwise contraindicated.

In patients with ST-segment elevation MI in whom PCI is planned, ACC/AHA, Society for Cardiovascular Angiography and Interventions (SCAI) and ACCP recommend pretreatment with a loading dose of clopidogrel in conjunction with aspirin therapy.

Recommended by ACC/AHA in combination with aspirin as short-term prophylaxis (≥ 1 month) in patients with ST-segment elevation MI who have undergone PCI with bare-metal coronary artery stent implantation.

Ideally, use long term (≥1 year) in conjunction with aspirin therapy in patients with ST-segment elevation MI who have undergone PCI with bare-metal stent implantation and are at low risk of bleeding.

Recommended as short-term (≥2 weeks) monotherapy in patients with ST-segment elevation MI who have undergone PCI with bare-metal stent implantation and are at high risk of bleeding.

Prolonged (≥1 year) prophylaxis in combination with aspirin strongly recommended in patients who have undergone PCI with DES implantation and are not at high risk of bleeding. (See Thrombosis Associated with Drug-eluting Stents under Cautions.)

Suggested by American Diabetes Association (ADA) as alternative to aspirin for primary prevention of MI† in aspirin-allergic patients with type 1 or type 2 diabetes mellitus who are at high risk for cardiovascular events. Such patients include those with family history of CHD, smoking, hypertension, obesity, albuminuria, and elevated blood cholesterol or triglyceride concentrations).

Chronic Stable Angina

Use in combination with aspirin suggested by ACCP for reduction of the risk of AMI in high-risk patients with symptomatic chronic stable angina†.

Used as an alternative to aspirin in patients with symptomatic chronic stable angina who cannot tolerate aspirin†.

Other Uses

Aspirin generally recommended for all clinical conditions in which antiplatelet prophylaxis has a favorable benefit-to-risk profile. However, use recommended by ACCP as alternative and/or adjunctive antithrombotic therapy in selected patients with a number of atherosclerotic and ischemic conditions, including rheumatic mitral valve disease† and saphenous vein CABG†.

Use in combination with aspirin in patients undergoing brachytherapy for restenosis following PCI and coronary artery stent implantation† suggested by ACC and AHA.

Considered a reasonable choice for antiplatelet therapy in high-risk patients with prosthetic heart valves in whom aspirin cannot be used† or in patients with prosthetic heart valves receiving aspirin who have breakthrough embolic events†.