Clopidogrel [Neurosurgery Wiki]

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====== Clopidogrel ======

Clopidogrel (also known as [[Plavix]]) is an antiplatelet drug, which means that it prevents blood cells called platelets from sticking together (aggregating) and forming blood clots 

A platelet [[adenosine diphosphate receptor inhibitor]].

Clopidogrel ([[Plavix]], [[Bristol-Myers Squibb]]/Sanofi-Aventis) is a prodrug requiring hepatic metabolism by [[cytochrome P450]] (CYP) isoenzymes to generate an active [[metabolite]] that is responsible for irreversible blocking of its target, the platelet [[adenosine diphosphate]] ([[ADP]]) [[P2Y12]] receptor. Numerous investigations have demonstrated a broad interindividual variability in clopidogrel-induced [[antiplatelet]] effects. Notably, patients with high on-treatment platelet reactivity (HPR) have an increased risk of recurrent ischemic events, including [[stent thrombosis]]. Genetic and environmental factors modulating hepatic metabolism of clopidogrel have shown to significantly contribute to these findings.

===== Indications =====

Clopidogrel therapy is mandatory for six weeks after [[stenting]] to allow [[endothelialization]].

● [[Prevention]] of intra-procedural and short-term post-procedural (4–12 weeks) [[thromboembolic event]]s related to [[endovascular]] [[procedure]]s including

○ [[Coil embolization]] of wide-neck cerebral aneurysms where stent will be used

○ [[Stent]] [[implantation]] (with a second antiplatelet agent)

○ Therapeutic occlusion of large arteries (often with a second antiplatelet agent)

● Subacute management of procedural complications (alone or in combination with a second agent)

○ Parent artery coil herniations

○ Thrombus or clot on coil phenomena

○ In-stent thrombus (may be more effective than other agents).

===== Dosing =====

[[Clopidogrel Dosing]].


===== Reversal =====

[[Platelet transfusion]].

===== Effects of cigarette smoking on clopidogrel =====

see [[Effects of cigarette smoking on clopidogrel]].