Clopidogrel

(Plavix®)

Plavix®

Drug updated on 11/4/2024

Dosage FormTablet (oral; 75 mg, 300 mg)
Drug ClassP2Y12 platelet inhibitors
Ongoing and
Completed Studies
ClinicalTrials.gov

Indication

  • Indicated for acute coronary syndrome for patients with nonST-segment elevation ACS (unstable angina [UA]/nonST-elevation myocardial infarction [NSTEMI]), Plavix has been shown to reduce the rate of myocardial infarction (MI) and stroke
  • Indicated for acute coronary syndrome for patients with ST-elevation myocardial infarction (STEMI), Plavix has been shown to reduce the rate of MI and stroke
  • Indicated for recent MI, recent stroke, or established peripheral arterial disease
  • Plavix has been shown to reduce the rate of MI and stroke

Latest News

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Summary
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  • This summary is based on the review of 65 systematic review(s)/meta-analysis(es). [1-65]
  • Major Adverse Cardiac and Cerebrovascular Events (MACCE): A 1-month DAPT followed by P2Y12 inhibitors showed no difference in MACCE compared to 12 months of DAPT (RR (relative risk), 1.00; 95% CrI, 0.70-1.41), while a 3-month DAPT followed by P2Y12 inhibitors ranked optimal for reducing MACCE (RR, 0.85; 95% CrI, 0.56-1.21). Clopidogrel compared to aspirin monotherapy was associated with a 28% reduction in MACE (HR (hazard ratio), 0.72; 95% CI (confidence interval), 0.54-0.98).
  • Stroke: Aspirin plus clopidogrel reduced the risk of ischemic stroke by 28% compared to aspirin monotherapy (RR, 0.72; 95% CI, 0.65-0.80). Ticagrelor also showed a reduced stroke risk compared to clopidogrel (RR, 0.64; 95% CI, 0.42-0.98).
  • Mortality: No significant difference in all-cause mortality was observed between clopidogrel and aspirin monotherapy (RR, 0.87; 95% CI, 0.53-1.41). However, ticagrelor reduced all-cause mortality compared to clopidogrel (HR, 0.85; 95% CI, 0.75-0.97).
  • Safety - Major Bleeding: One-month DAPT followed by P2Y12 inhibitors reduced major bleeding relative to 12 months of DAPT (RR, 0.47; 95% CrI, 0.26-0.74). In contrast, ticagrelor, compared to clopidogrel, was associated with a higher risk of major bleeding (HR, 1.21; 95% CI, 1.02-1.44).
  • Clopidogrel vs. Aspirin Monotherapy: No significant difference in clinically relevant bleeding (HR, 0.92; 95% CI, 0.68-1.24).
  • Aspirin plus Clopidogrel vs. Aspirin Monotherapy: Increased risk of moderate or severe bleeding (RR, 1.88; 95% CI, 1.10-3.23).
  • Acute Coronary Syndrome (ACS) patients undergoing PCI demonstrated a reduction in major bleeding with 1-month DAPT followed by P2Y12 inhibitors, while post-PCI ACS patients showed a reduction in MACE with clopidogrel vs. aspirin monotherapy; a de-escalation strategy effectively reduced bleeding without increasing thrombotic events in ACS patients.
  • In elderly ACS patients, ticagrelor reduced all-cause and cardiovascular mortality but increased bleeding risk; in Chronic Kidney Disease (CKD) patients, antiplatelet therapy reduced myocardial infarction but raised major bleeding risks.

Product Monograph / Prescribing Information

Document TitleYearSource
Plavix (clopidogrel) Prescribing Information.2022Sanofi-Aventis U.S. LLC., Bridgewater, NJ

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Short-Term Dual Antiplatelet Therapy After Drug-Eluting Stenting in Patients With Acute Coronary Syndromes: A Systematic Review and Network Meta-Analysis2024JAMA Cardiology
Comparison of efficacy and safety of sarpogrelate-based anti-platelet therapy with non-sarpogrelate-based anti-platelet therapy following arterial endovascular therapy: a systematic review2024Annals of Medicine and Surgery
Clopidogrel Versus Aspirin as Monotherapy Following Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome Receiving a Drug-Eluting Stent: A Systematic Literature Review and Meta-Analysis2024Clinical Cardiology
Efficacy and safety of aspirin plus clopidogrel versus aspirin alone in ischemic stroke or high-risk transient ischemic attack: A meta-analysis of randomized controlled trials2024Vascular Medicine (London, England)
Antiplatelet Resistance in Coronary Artery Bypass Grafting: A Systematic Review2024Surgery Research and Practice
Potent P2Y(12) Inhibitor Selection and De-escalation Strategies in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: Systematic Review and Meta-analysis2024CJC Open
Comparative effects of different antiplatelet strategies in carriers of CYP2C19 loss-of-function alleles: a network meta-analysis2024European Heart Journal
Comparison of clopidogrel and ticagrelor in treating acute coronary syndrome undergoing PCI: A systematic review and meta-analysis2024Heliyon
Comprehensive comparative efficacy and safety of potent P2Y(12) inhibitors in patients undergoing coronary intervention: A systematic review and meta-analysis2024International Journal of Cardiology
Bivalirudin versus heparin in contemporary percutaneous coronary interventions for patients with acute coronary syndrome: a systematic review and meta-analysis2024Cardiology Journal
Efficacy and Safety Profile of Ticagrelor Versus Clopidogrel in Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS): A Systematic Review and Meta-Analysis2023Cureus
The effect of ticagrelor on coronary microvascular function after PCI in patients with ACS compared to clopidogrel: A systematic review and meta-analysis2023PLoS One
Lower Plasma miR-223 Level Is Associated with Clopidogrel Resistance in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis2023Journal of Interventional Cardiology
Effect of pretreatment with a P2Y(12) inhibitor in patients with non-ST-elevation acute coronary syndrome: a systematic review and network meta-analysis2023Frontiers in Cardiovascular Medicine
P2Y(12) Inhibitor or Aspirin Monotherapy for Secondary Prevention of Coronary Events2023Journal of the American College of Cardiology
Antithrombotic regimens for the prevention of major adverse cardiac events in chronic coronary syndrome: A systematic review and network meta-analysis2023Frontiers in Cardiovascular Medicine
Hypoglycemia as a potential risk for patients taking clopidogrel: A systematic review and meta-analysis2023Frontiers in Endocrinology
Prophylactic Efficacy and Safety of Antithrombotic Regimens in Patients with Stable Atherosclerotic Cardiovascular Disease (S-ASCVD): A Bayesian Network Meta-Regression Analysis2023American Journal of Cardiovascular Drugs
Clopidogrel Vs Aspirin Monotherapy Following Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis2023Current Problems in Cardiology
Efficacy and safety outcomes of long-term anti-thrombotic treatment of chronic coronary artery disease: A systematic review and network meta-analysis2022Frontiers in Cardiovascular Medicine
Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials2022Frontiers in Pharmacology
Antithrombotic Therapy for Symptomatic Peripheral Arterial Disease: A Systematic Review and Network Meta-Analysis2022Drugs
CYP2C19 polymorphism and coronary in-stent restenosis: A systematic review and meta-analysis2022F1000 Research
Antiplatelet agents and anticoagulants for hypertension2022The Cochrane Database of Systematic Reviews
Clinical Efficacy and Safety of Reduced-Dose Prasugrel versus Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials2022Acta Cardiologica Sinica
P2Y12 inhibitor pretreatment in patients with nonST-segment elevation acute coronary syndrome: A meta-analysis2022Medicine
Clinical non-effectiveness of clopidogrel use for peripheral artery disease in patients with CYP2C19 polymorphisms: a systematic review2022European Journal of Clinical Pharmacology
Early vs. Delayed Initiation of Treatment With P2Y(12) Inhibitors in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials2022Frontiers in Cardiovascular Medicine
High-Dose Clopidogrel versus Ticagrelor in CYP2C19 intermediate or poor metabolizers after percutaneous coronary intervention: A Meta-Analysis of Randomized Trials2022Journal of Clinical Pharmacy and Therapeutics
Contemporary antiplatelet therapy for secondary stroke prevention: a narrative review of current literature and guidelines2022Stroke and Vascular Neurology
P2Y12 inhibitors plus aspirin for acute treatment and secondary prevention in minor stroke and high-risk transient ischemic attack: A systematic review and meta-analysis2022European Journal of Internal Medicine
Antiplatelet agents for chronic kidney disease2022The Cochrane Database of Systematic Reviews
Platelet Biomarkers in Patients with Atherosclerotic Extracranial Carotid Artery Stenosis: A Systematic Review2022European Journal of Vascular and Endovascular Surgery
A Systematic Review and Meta-Analysis on the Impact of High On-Treatment Platelet Reactivity on Clinical Outcomes for Patients Taking ADP Receptor Inhibitors Following Lower Limb Arterial Endovascular Intervention2022European Journal of Vascular and Endovascular Surgery
Combination anticoagulant or P2Y12 inhibitor with low-dose aspirin versus low-dose aspirin alone in patients at risk or with documented coronary and/or peripheral artery disease2022Current Medical Research and Opinion
P2Y12 receptor inhibitor plus aspirin versus aspirin treated within 24 hours of acute noncardioembolic ischemic stroke or TIA: Meta-analysis2022Journal of the Formosan Medical Association
Aspirin Alone Versus Dual Antiplatelet Therapy after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis2022Cardiovascular Drugs and Therapy
Antithrombotic therapy with or without clopidogrel after transcatheter aortic valve replacement. A meta-analysis of randomized controlled trials2022Clinical Research in Cardiology
The Effect of Ticagrelor on Endothelial Function Compared to Prasugrel, Clopidogrel, and Placebo: A Systematic Review and Meta-Analysis2021Frontiers in Cardiovascular Medicine
Comparison of Safety and Efficacy Between Clopidogrel and Ticagrelor in Elderly Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis2021Frontiers in Pharmacology
Network Meta-analysis of the Benefit of Aspirin with Rivaroxaban vs. Clopidogrel for Patients with Stable Symptomatic Lower Extremity Arterial Disease2021European Journal of Vascular and Endovascular Surgery
De-Escalation of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndromes2021Journal of the American College of Cardiology
Dual Antiplatelet Therapy vs. Single Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: An Updated Systematic Review and Meta-Analysis2021Frontiers in Cardiovascular Medicine
Efficacy and Safety of Aspirin Combined with Low-Dose P2Y12 Receptor Antagonists in East Asian Patients Undergoing PCI2021International Heart Journal
Antiplatelet therapy after transcatheter aortic valve implantation: a systematic review and meta-analysis2021European Journal of Cardio-Thoracic Surgery
P2Y12 Inhibitors Plus Aspirin Versus Aspirin Alone in Patients With Minor Stroke or High-Risk Transient Ischemic Attack2021Stroke
P2Y12 Antiplatelet Choice for Patients with Chronic Kidney Disease and Acute Coronary Syndrome: A Systematic Review and Meta-Analysis2021Journal of Personalized Medicine
Reduced-Dose Prasugrel versus Clopidogrel for Patients Undergoing Percutaneous Coronary Intervention2021International Heart Journal
Association of CYP2C19 Loss-of-Function Alleles with Major Adverse Cardiovascular Events of Clopidogrel in Stable Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention: Meta-analysis2021Cardiovascular Drugs and Therapy
Ticagrelor as compared to conventional antiplatelet agents in coronary artery disease: A comprehensive meta-analysis of 15 randomized trials2021Vascular Pharmacology
P2Y(12) inhibitor monotherapy and dual antiplatelet therapy after percutaneous coronary intervention: An updated meta-analysis of randomized trials2021Thrombosis Research
Pharmacodynamic and clinical efficacy of reduced ticagrelor maintenance doses in patients with coronary artery disease2021Current Medical Research and Opinion
Efficacy and Safety of Antiplatelet Therapies in Symptomatic Peripheral Artery Disease: A Systematic Review and Network Meta-Analysis2021Current Vascular Pharmacology
Very short dual antiplatelet therapy after PCI and new DES: a meta-analysis of 5 randomized trials2021Revista Espanola De Cardiologia (English Ed.)
Effects of the ABCB1 C3435T single nucleotide polymorphism on major adverse cardiovascular events in acute coronary syndrome or coronary artery disease patients undergoing percutaneous coronary intervention and treated with clopidogrel: A systematic review and meta-analysis2020Expert Opinion On Drug Safety
Efficacy and safety of newer P2Y(12) inhibitors for acute coronary syndrome: a network meta-analysis2020Scientific Reports
Antithrombotic Treatments in Patients with Chronic Coronary Artery Disease or Peripheral Artery Disease: A Systematic Review of Randomised Controlled Trials2020Cardiovascular Therapeutics
Efficacy and safety of low dose ticagrelor in patients with acute coronary syndrome: a systematic review and meta-analysis2020Postgraduate Medical Journal
Comparative Efficacy and Safety of Oral P2Y(12) Inhibitors in Acute Coronary Syndrome: Network Meta-Analysis of 52 816 Patients From 12 Randomized Trials2020Circulation
Efficacy and safety of clopidogrel versus prasugrel and ticagrelor for coronary artery disease treatment in patients with CYP2C19 LoF alleles: a systemic review and meta-analysis2020British Journal of Clinical Pharmacology
Long-term effect of clopidogrel in patients with and without diabetes: A systematic review and meta-analysis of randomized controlled trials2020World Journal of Diabetes
Antithrombotic therapy in the early phase of non-ST-elevation acute coronary syndromes: a systematic review and meta-analysis2020European Heart Journal
De-escalation versus standard dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis2020Platelets
Cilostazol Mono and Combination Treatments in Ischemic Stroke: An Updated Systematic Review and Meta-Analysis2019Stroke
Ticagrelor after pharmacological thrombolysis in patients with ST-segment elevation myocardial infarctions: insight from a trial sequential analysis2019Journal of Thrombosis and Thrombolysis

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