Modern Antiplatelet Therapy: When Is Clopidogrel the Right Choice?

Abstract

Platelet inhibition with aspirin is the cornerstone of medical therapy for coronary artery disease. In the era of percutaneous coronary intervention with drug-eluting stents, dual anti-platelet therapy with the addition of clopidogrel (Plavix©, Bristol-Myers Squibb, New York, NY) became the mainstay of therapy. However, with the advent of newer oral antiplatelet medications, including prasugrel (Effient©, Eli Lilly, Indianapolis, Indiana) and ticagrelor (Brilinta©, Astra-Zeneca, Cambridge, United Kingdom), choosing the appropriate platelet inhibitor has become more nuanced. The optimal regimen differs based on patient characteristics, clinical situation, and the condition being treated, with differing risk and safety profiles for these medications. This review explores the appropriate use of antiplatelet therapy for stable ischemic heart disease, acute coronary syndrome, stroke, and peripheral vascular disease. Furthermore, we evaluate the data behind the use of antiplatelet therapy in patients on oral anticoagulation. By understanding the biochemistry of platelet aggregation, the pharmacology of platelet inhibitors, and the extensive clinical trial data that informs current guideline recommendations we aim to better understand the role of clopidogrel in patients with cardiovascular disease.