Indications
for the use of aspirin in combination with clopidogrel| Indication | Dose and Duration of Treatment / Comments |
Acute Coronary Syndrome Patients (without ST-segment-elevation) |
|
| High risk patients not undergoing a percutaneous coronary intervention (PCI) |
Clopidogrel 75mg daily for up to 12 months – duration must be specified
by cardiologist. Maximum benefit seen during first 3 months, NICE advise up to 12 months is cost effective. Duration of treatment should be determined following an assessment of benefits vs. risk of bleeding. |
| Patients undergoing a PCI |
Clopidogrel 75mg daily for 9 months. Recommendation from European Society of Cardiology. |
Non Acute Coronary Syndrome Patients Undergoing PCI |
|
| Uncomplicated PCI with placement of a bare metal stent in a single vessel >3mm diameter. |
Clopidogrel 75mg daily for 28 days. Recommendation from European Society of Cardiology. |
| PCI in vessel(s) <3mm with placement of one or more drug eluting stents. (NICE guidance states that this will be in vessels <3mm in diameter or where lesions >15mm in length) |
Clopidogrel 75mg daily for 6 to 9 months. In accordance with stent manufacturer's instructions. |
| PCI procedure to left main stem coronary artery. |
Clopidogrel 75mg daily – duration must be specified by cardiologist. Lifelong treatment may be appropriate in patients with poor prognosis for long term survival, otherwise up to 9 to 12 months treatment may be appropriate. |
Notes
- Patients undergoing PCI should receive a loading dose of clopidogrel 300mg at least 2 hours 1 before the intervention
- The recommended dose of aspirin in patients following PCI is 75mg daily — analysis of data from the CURE study indicated that doses of aspirin above 100mg daily give no additional protection and are associated with an increased risk of haemorrhage.
- When referring patients back to the care of their GP it is essential that hospital doctors give I clear instructions regarding the discontinuation of clopidogrel e.g. after 9 months.
- Clopidogrel should be discontinued in patients following coronary artery bypass graft (CABG) unless there is still a specific indication for its use.
- When Clopidogrel course is completed, aspirin must continue.
- There is no evidence for using the combination in other indications.
References
- SPC Plavix. Accessed by website
- Guidance on the use of Clopidogrel. Caerphilly Drug and Therapeutics Committee. June 2003
- In what circumstances might Aspirin "intolerance" be an appropriate indication for Clopidogrel? UKMI March 2003
- British National Formulary. March 2004; 47: 118-119
- Clopidogrel Drug Update. Regional Drug and Therapeutics Centre. March 2004
- Recommendations on Use of Oral Antiplatelets Aspirin and Clopidogrel. Newcastle and North Tyneside Drug and Therapeutics Committee. Jan 2004
- Strategies against NSAID-induced gastrointestinal side effects. F. MacRae et al. The Pharmaceutical Journal. 2004;272:219-221