Prevention of atherothrombotic events in percutaneous
coronary intervention (adjunct with aspirin) in patients
not already on clopidogrel
▶BY MOUTH
▶Adult: Loading dose 300 mg, to be taken prior to the
procedure, alternatively loading dose 600 mg, higher
dose may produce a greater and more rapid inhibition
of platelet aggregation
Transient ischaemic attack for patients with aspirin
hypersensitivity, or those intolerant of aspirin despite
the addition of a proton pump inhibitor | Acute ischaemic
stroke for patients with aspirin hypersensitivity, or
those intolerant of aspirin despite the addition of a
proton pump inhibitor
▶BY MOUTH
▶Adult: 75 mg once daily
Prevention of atherothrombotic events in peripheral
arterial disease or within 35 days of myocardial
infarction, or within 6 months of ischaemic stroke
▶BY MOUTH
continued →
▶Adult: 75 mg once daily
Prevention of atherothrombotic events in acute coronary
syndrome without ST-segment elevation (given with
aspirin)
▶BY MOUTH
Cardiovascular system
▶Adult: Initially 300 mg, then 75 mg daily for up to
12 months
Prevention of atherothrombotic events in acute
myocardial infarction with ST-segment elevation (given
with aspirin)
▶BY MOUTH
▶Adult 18–75 years: Initially 300 mg, then 75 mg for at
least 4 weeks
▶Adult 76 years and over: 75 mg daily for at least 4 weeks
Prevention of atherothrombotic and thromboembolic
events in patients with atrial fibrillation and at least one
risk factor for a vascular event (with aspirin) and for
whom warfarin is unsuitable
▶BY MOUTH
▶Adult: 75 mg once daily
l UNLICENSED USE 600 mg loading dose prior to
percutanous coronary intervention is an unlicensed dose.
Use in transient ischaemic attack or acute ischaemic
stroke, in patients with aspirin hypersensitivity or
intolerant of aspirin, is unlicensed.
PDF pages 153, 154
Active bleeding
PDF page 154
Discontinue 7 days before elective surgery if
antiplatelet effect not desirable. patients at risk of
increased bleeding from trauma, surgery, or other
pathological conditions
CAUTIONS, FURTHER INFORMATION
▶Elderly Prescription potentially inappropriate (STOPP
criteria) with concurrent significant bleeding risk, such as
uncontrolled severe hypertension, bleeding diathesis or
recent non-trivial spontaneous bleeding (high risk of
bleeding). See also Prescribing in the elderly p. 33.
PDF page 154
Caution with history of
hypersensitivity reactions to thienopyridines (e.g.
prasugrel).
PDF page 154
NICE decisions
▶Clopidogrel and modified-release dipyridamole for the
prevention of occlusive vascular events (December 2010)
NICE TA210
The guidance applies to patients who have had an
occlusive vascular event, or who have established
peripheral arterial disease. The guidance does not apply to
patients who have had, or are at risk of, stroke associated
with atrial fibrillation, or who need prophylaxis for
occlusive events following coronary revascularisation or
carotid artery procedures.
Clopidogrel monotherapy is recommended as an option
to prevent occlusive vascular events in patients who have
had:
. an ischaemic stroke, or who have peripheral arterial
disease or multivascular disease, or
. a myocardial infarction, only if aspirin is contra-
indicated or not tolerated.
www.nice.org.uk/guidance/ta210
Scottish Medicines Consortium (SMC) decisions
SMC No. 88/04
The Scottish Medicines Consortium has advised (March
2004) that clopidogrel (Plavix ®) is accepted for restricted
use within NHS Scotland for the treatment of confirmed
acute coronary syndrome (without ST-segment elevation),
in combination with aspirin. Clopidogrel should be
initiated in hospital inpatients only.
SMC No. 390/07
The Scottish Medicines Consortium has advised (August
2007) that clopidogrel (Plavix ®) is accepted for restricted
use within NHS Scotland for patients with ST-segment
elevation acute myocardial infarction in combination with
aspirin; treatment with clopidogrel is restricted to 4 weeks
only.
PDF page 154
