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Plavix Generic Name: clopidogrel (kloh PID oh grel) What is the most important information I should know about Plavix? Many conditions can put you at increased risk for a future heart attack or stroke, including recent heart attack, recent stroke, or established peripheral artery disease, or P.A.D.—poor circulation in the legs that may cause pain during exercise, such as walking, and may be relieved by rest. Doctors have prescribed PLAVIX for over 8 years to millions of people worldwide. Compared to the general population, people who have had a heart attack face a 5 times greater risk of another heart attack and 3 times greater risk of stroke. People who have had a stroke have 9 times the risk of having another stroke and twice the risk of having a heart attack. And, those with P.A.D. have twice the risk of having a stroke and 4 times the risk of dying from a heart attack. If you need to have any type of surgery or dental work, tell the surgeon or dentist ahead of time that you are using Plavix. You may need to stop using the medicine for at least 5 days before having surgery, to prevent excessive bleeding. While you are taking Plavix, do not take aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) without your doctors advice. NSAIDs include ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), piroxicam (Feldene), and others.	Clopidogrel is used to prevent strokes and heart attacks in patients at risk for these problems. Clopidogrel is in a class of medications called antiplatelet drugs. It works by helping to prevent harmful blood clots.
Clopidogrel is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. It is marketed by Bristol-Myers Squibb and Sanofi-Aventis under the trade name Plavix. In 2006, generic clopidogrel was briefly marketed by Apotex, a Canadian generic pharmaceutical company before a court order halted further production until resolution of a patent infringement case brought by Bristol-Myers Squibb.
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plavix clopidogrel medication	However many patients and healthcare providers prematurely discontinue dual antiplatelet therapy which greatly increases the risk of stent thrombosis myocardial infarction and death. the American College of Cardiology Foundation the Society for Cardiovascular Angiography and Interventions the American College of Surgeons and the American Dental Association. The leading adverse event associated with early antiplatelet discontinuation is stent thrombosis and the majority of these events lead to acute myocardial infarction (MI) or death. After Bare-Metal Stent Placement Aspirin Plus Thienopyridine Reduces Cardiac Events Compared With Aspirin Alone or With Oral Antithrombins Study No. * Cardiac death acute MI or repeat target-vessel revascularization at 30 days (except for the FANTASTIC study). In a pooled analysis of 6 trials and registries from the 1990s the incidence of death or MI associated with angiographically documented stent thrombosis was found to be 64. Late (1 to 12 months) stent thrombosis was not readily apparent with bare-metal stents yet was reported to occur in 0. The panel also agreed that in the future new DES studies should have longer follow-up enroll greater numbers of patients and include stent thrombosis as a study end point. However they agreed that a large randomized trial looking specifically at appropriate duration of dual antiplatelet therapy is needed. Although the number of actual stent thromboses reported in individual studies is modest the findings are noteworthy. In a large observational cohort study of patients treated with DES stent thrombosis occurred in a striking 29% of patients in whom antiplatelet therapy was discontinued prematurely. 8%) of 64 patients with premature interruption of aspirin clopidogrel or both experienced stent thrombosis. The mortality rate over the next 11 months of those who stopped thienopyridine therapy was 7. 7% in those who had not stopped therapy (hazard ratio 9. Although the rates of stent thrombosis were not reported it is reasonable to presume that many of the deaths were related to coronary artery disease. All patients received dual antiplatelet therapy for 6 months after which aspirin alone was continued. At 30 days rates of death or nonfatal MI were lower in the DES group (2. 05); however after discontinuation of clopidogrel at 6 months late stent thrombosis (2. In patients treated with bare-metal stents continued use of clopidogrel did not influence death or MI rates between 6 and 24 months. Conversely in DES patients extended use of clopidogrel at 6 12 and 24 months was associated with reduced death or death/MI rates at all time intervals. Stent thrombosis was presumed to be the cause of all MIs. In 5 of 7 cases thienopyridine therapy (ticlopidine) had been withheld before surgery. The cost of clopidogrel (approximately $4 daily) has been cited as one reason patients discontinue (or do not renew) their therapy. Like all antithrombotic agents both aspirin and clopidogrel increase the risk of bleeding compared with placebo. When compared with aspirin clopidogrel may be associated with lower risk of GI bleeding. Independent documentation of the scope of this risk of increased bleeding during noncardiac surgery however is not available. Summary and Recommendations Thienopyridine therapy in combination with aspirin has become the mainstay antiplatelet treatment strategy for the prevention of stent thrombosis. Premature discontinuation of antiplatelet therapy markedly increases the risk of stent thrombosis a catastrophic event that frequently leads to MI and/or death. To eliminate premature discontinuation of thienopyridine therapy this advisory group gives the following recommendations. Before implantation of a stent the physician should discuss the need for dual antiplatelet therapy. In patients not expected to comply with 12 months of thienopyridine therapy whether for economic or other reasons strong consideration should be given to avoiding a DES. Such professionals who perform these procedures should contact the patient's cardiologist if issues regarding the patient's antiplatelet therapy are unclear to discuss optimal patient management strategy. Writing Group Disclosures Writing group member Organization represented Employment Research grant Other research support Speakers' bureau/ Honoraria Ownership interest Consultant / Advisory board Other Cindy L. Grines AHA Representative William Beaumont Hospital None None None None None None Robert O. Bonow AHA Representative Northwestern University None None None None None None Donald E. Casey Jr ACP Representative Atlantic Health None None None None None None Timothy J. Gardner ACS Representative Christiana Care Health System None None None None None None Peter B. Lockhart ADA Representative Carolinas Medical Center None None None None None None David J. Reviewer Disclosures Reviewer Employment Research grant Other research support Speakers' bureau/ Honoraria Expert witness Ownership interest Consultant / Advisory board Other Elliott M. Antman Brigham and Women's Hospital Eli Lilly* None None None None None None Gregory J. Bruce Ferguson East Carolina University None None None None None None None Raymond J. Gibbons Mayo Clinic Radiant Medical * KAI Pharmaceuticals * TargeGen * TherOx * None None None None Hawaii Biotech * TIMI 37A* None Arthur H. Antiplatelet and anticoagulant therapy in elective percutaneous coronary intervention. Smith SC Jr Feldman TE Hirshfeld JW Jr Jacobs AK Kern MJ King SB III Morrison DA O'Neill WW Schaff HV Whitlow PL Williams DO. Smith SC Jr Allen J Blair SN Bonow RO Brass LM Fonarow GC Grundy SM Hiratzka L Jones D Krumholz HM Mosca L Pasternak RC Pearson T Pfeffer MA Taubert KA. Joner M Finn AV Farb A Mont EK Kolodgie FD Ladich E Kutys R Skorija K Gold HK Virmani R. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. Angioscopic findings of the neo-intimal coverage over the sirolimus-eluting stent: nine months follow-up study. Nebeker JR Virmani R Bennett CL Hoffman JM Samore MH Alvarez J Davidson CJ McKoy JM Raisch DW Whisenant BK Yarnold PR Belknap SM West DP Gage JE Morse RE Gligoric G Davidson L Feldman MD. Hypersensitivity cases associated with drug-eluting coronary stents: a review of available cases from the Research on Adverse Drug Events and Reports (RADAR) project. Virmani R Guagliumi G Farb A Musumeci G Greico N Motta T Mihalcsik L Tespili M Valsecchi O Kolodgie FD. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: should we be cautious. Iakovou I Schmidt T Bonizzoni E Ge L Sangiorgi GM Stankovic G Airoldi F Chieffo A Montorfano M Carlino M Michev I Corvaja N Briquori C Gerckens U Grube E Colombo A. Incidence predictors and outcome of thrombosis after successful implantation of drug-eluting stents. Levine GN Kern MJ Berger PB Brown DL Klein LW Kereiakes DJ Sanborn TA Jacobs AK. Management of patients undergoing percutaneous coronary revascularization. McFadden EP Stabile E Regar E Cheneau E Ong AT Kinnaird T Suddath WO Weissman NJ Torguson R Kent KM Pichard AD Satler LF Waksman R Serruys PW. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Ong AT McFadden EP Regar E de Jaegere PP van Domburg RT Serruys PW. Late angiographic stent thrombosis (LAST) events with drug-eluting stents. Park DW Park SW Park KH Lee BK Kim YH Lee CW Hong MK Kim JJ Park SJ. Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. Cutlip DE Baim DS Ho KK Popma JJ Lansky AJ Cohen DJ Carrozza JP Jr Chauhan MS Rodriguez O Kuntz RE. Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Moussa I Di Mario C Reimers B Akiyama T Tobis J Colombo A.
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