Clopidogrel

(Plavix®)

Plavix®

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Drug updated on 4/17/2024

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 non–ST-segment elevation ACS (unstable angina [UA]/non–ST-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.

Summary
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  • Clopidogrel (Plavix) is indicated for acute coronary syndrome, reducing the rate of myocardial infarction and stroke in patients with non-ST-segment elevation ACS, ST-elevation myocardial infarction, recent MI or stroke, and established peripheral arterial disease.
  • The information is based on 26 systematic reviews/meta-analyses focusing on the effectiveness and safety of clopidogrel compared to drugs like aspirin, ticagrelor, prasugrel, among others.
  • In comparison to aspirin post-percutaneous coronary intervention (PCI), clopidogrel significantly reduced major adverse cardiac events without an increase in mortality or major bleeding.
  • Ticagrelor was found superior in reducing the risk of all-cause mortality, MI, and stroke when compared to clopidogrel but had a higher risk of bleeding, which suggests that a balance between efficacy and safety needs consideration.
  • For East Asian patients treated with PCI for Acute Coronary Syndrome (ACS), ticagrelor increased the risk of bleeding without showing superiority over clopidogrel, indicating population-specific considerations are important.
  • A de-escalation strategy was associated with reduced net adverse clinical events (NACE), suggesting certain dual antiplatelet therapy (DAPT) strategies may offer benefits over standard DAPT with clopidogrel.
  • Both Prasugrel and Ticagrelor showed comparable risks for all endpoints when compared against clopidogrel. However, they might also increase the risk of major bleeding.
  • Clopidogrel monotherapy was associated with a lower primary composite outcome than Aspirin Monotherapy without a significant increase in Major Bleeding, making it a preferable option for long-term secondary prevention.

Product Monograph / Prescribing Information

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

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Clopidogrel vs aspirin monotherapy following dual antiplatelet therapy after percutaneous coronary intervention: a systematic review and meta-analysis.2023Current Problems in Cardiology
Efficacy and safety profile of ticagrelor versus clopidogrel in percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS): a systematic review and meta-analysis.2023Cureus
Safety and efficacy of ticagrelor versus clopidogrel in east asian patients with acute coronary syndrome undergoing percutaneous coronary intervention treated with dual antiplatelet therapy: a meta-analysis of randomized controlled trials.2023Cardiology
Strategy of dual antiplatelet therapy for patients with ST-elevation myocardial infarction and non-ST-elevation acute coronary syndromes: a systematic review and network meta-analysis.2023International Journal of Cardiology
P2Y12 inhibitors for non-ST-segment elevation acute coronary syndrome: a systematic review and network meta-analysis. 2023Texas Heart Institute Journal
Effect of pretreatment with a P2Y12 inhibitor in patients with non-ST-elevation acute coronary syndrome: a systematic review and network meta-analysis. 2023Frontiers in Cardiovascular Medicine
P2Y12 inhibitor or aspirin monotherapy for secondary prevention of coronary events. 2023Journal of the American College of Cardiology
Short-term DAPT and DAPT de-escalation strategies for patients with acute coronary syndromes: a systematic review and network meta-analysis.2023Circulation. Cardiovascular Interventions
Efficacy of ticagrelor compared to clopidogrel in improving endothelial function in patients with coronary artery disease: a systematic review.2022Journal of Cardiovascular Medicine
Comparison of ticagrelor with clopidogrel in east Asian patients with acute coronary syndrome: a systematic review and meta-analysis of randomized clinical trials.2022Journal of Cardiovascular Pharmacology
P2Y12 inhibitor pretreatment in patients with nonST-segment elevation acute coronary syndrome: a meta-analysis.2022Medicine
Early vs. delayed initiation of treatment with P2Y12 inhibitors in patients with non-ST-segment elevation acute coronary syndrome: a systematic review and network meta-analysis of randomized controlled trials. 2022Frontiers in Cardiovascular Medicine
Potent P2Y12 inhibitors versus clopidogrel in elderly patients with acute coronary syndrome: systematic review and meta-analysis.2021American Heart Journal
Risk factors for bleeding and clinical ineffectiveness associated with clopidogrel therapy: a comprehensive meta-analysis.2020Clinical and Translational Science
Antithrombotic therapy with or without clopidogrel after transcatheter aortic valve replacement. A meta-analysis of randomized controlled trials.2020Clinical Research in Cardiology
Long-term effect of clopidogrel in patients with and without diabetes: a systematic review and meta-analysis of randomized controlled trials.2020World Journal of Diabetes
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-analysis.2020Expert Opinion on Drug Safety
Comparative efficacy and safety of oral P2Y12 inhibitors in acute coronary syndrome: network meta-analysis of 52 816 patients from 12 randomized trials. 2020Circulation
Efficacy and safety of newer P2Y12 inhibitors for acute coronary syndrome: a network meta-analysis.2020Scientific Reports
Meta-analysis comparing P2Y12 inhibitors in acute coronary syndrome.2020The American Journal of Cardiology
Antithrombotic therapy in the early phase of non-ST-elevation acute coronary syndromes: a systematic review and meta-analysis. 2020European Heart Journal. Cardiovascular Pharmacotherapy
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-analysis. 2020British Journal of Clinical Pharmacology
Comparison of prasugrel and clopidogrel used as antiplatelet medication for endovascular treatment of unruptured intracranial aneurysms: a meta-analysis.2019American Journal of Neuroradiology
The effect of CYP2C19 and nongenetic factors on clopidogrel responsiveness in the mena region: a systematic review.2019Clinical and Applied Thrombosis/Hemostasis
Optimal duration of aspirin plus clopidogrel after ischemic stroke or transient ischemic attack.2019Stroke: American Heart Association
Ticagrelor after pharmacological thrombolysis in patients with ST-segment elevation myocardial infarctions: insight from a trial sequential analysis.2019Journal of Thrombosis and Thrombolysis

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