Secondary prevention of atherothrombotic complications (in combination with ASA) in patients with acute coronary syndrome:
In adult patients after a recent myocardial infarction (from a few days to 35 days), a recent ischemic stroke (from 7 days to 6 months), or with diagnosed occlusive peripheral arterial disease, clopidogrel administration reduced the frequency of the combined endpoint, which included repeated ischemic stroke (with or without lethal outcome), repeated myocardial infarction (with or without lethal outcome) and other cardiovascular death & nbsp;
In adult patients with acute coronary syndrome:
- acute coronary syndrome without ST segment elevation (unstable angina pectoris / myocardial infarction without Q wave), including patients who should receive medical treatment and patients who are indicated for percutaneous coronary intervention (with or without stenting) or coronary artery bypass grafting (CABG). Clopidogrel intake reduced the incidence of the combined endpoint, which included cardiovascular death, myocardial infarction, or stroke, as well as the incidence of the combined endpoint, which included cardiovascular death, myocardial infarction, stroke, and refractory ischemia.
- acute myocardial infarction with ST segment elevation. Clopidogrel supplementation reduced all-cause mortality and the incidence of a combined endpoint that included death, recurrent myocardial infarction, or stroke.
Prevention of atherothrombotic and thromboembolic complications in adult patients with atrial fibrillation (atrial fibrillation).
It has been shown that in patients with atrial fibrillation with an increased risk of vascular complications, therapy with indirect anticoagulants that are vitamin K antagonists (VKA) is associated with greater clinical benefit compared to the use of ASA alone or a combination of clopidogrel with ASA in terms of reducing the risk of stroke.
Patients with atrial fibrillation (atrial fibrillation) who have at least one risk factor for the development of vascular complications who cannot take VKA (for example, if there is a special risk of bleeding, the patient's inability, in the opinion of the attending physician, to adequately control the INR (international normalized ratio) or if the patient does not accept VKA treatment), clopidogrel in combination with ASA is indicated to prevent atherothrombotic and thromboembolic complications, including stroke.
It was shown that clopidogrel in combination with ASA reduced the incidence of the combined endpoint, which included stroke, myocardial infarction, systemic thromboembolism outside the central nervous system, or cardiovascular death, mainly by reducing the incidence of stroke & nbsp.
Recent myocardial infarction, recent stroke, and diagnosed occlusive peripheral arteries
75 mg once a day
Acute coronary syndrome without ST-segment elevation (unstable angina pectoris, myocardial infarction without Q wave)
treatment should be started with a single dose of 300 mg loading dose, and then continued at a dosage of 75 mg once a day. Simultaneously with clopidogrel, it is necessary to take ASA in a dosage of 75 to 325 mg once a day. In the CURE clinical trial, most patients with acute coronary syndrome received additional heparin treatment
Acute ST-segment elevation myocardial infarction
75 mg once, taken together with ASA with or without the use of thrombolytics. Clopidogrel can be started with or without a loading dose. In patients over 75 years of age, clopidogrel treatment should be started without a loading dose
should be taken in a daily dose of 75 mg; in combination with clopidogrel, it is necessary to take ASA at a dosage of 75-100 mg daily
Pharmacogenetics (patients with a genetically determined reduced activity of the isoenzyme CYP2C19)
low activity of the isoenzyme CYP2C19 is associated with a decrease in the antiplatelet effect of clopidogrel. The regimen of higher doses (600 mg - loading dose, then 150 mg once a day daily) in patients with low activity of the isoenzyme CYP2C19 increases the antiplatelet effect of clopidogrel. In patients with low activity of the CYP2C19 isoenzyme, the use of higher doses of clopidogrel may be considered. The exact dosing regimen for this patient population has not been established in clinical trials that take into account clinical outcomes
There are contraindications, consult with a specialist before use