The role of clopidogrel in the management of ischemic heart disease

PURPOSE OF REVIEW: Platelet inhibition remains a key component in the prevention and treatment of ischemic heart disease. This review documents recent advances in the use of clopidogrel for the management of myocardial ischemia. RECENT FINDINGS: For the prevention of ischemic heart disease, the addition of clopidogrel is not superior to aspirin alone at reducing short or long-term major adverse cardiac events. In patients with ST-segment elevation myocardial infarction who receive thrombolytics, clopidogrel therapy confers broad benefits including survival when initiated at the time of presentation. Long-term administration of clopidogrel is necessary to prevent thrombotic complications following coronary stent placement. Overall, there are no major safety concerns across the spectrum of cardiac indications for clopidogrel. SUMMARY: Clopidogrel has become a cornerstone of therapy in the treatment of acute ischemic coronary syndromes and as prevention of thrombosis after coronary stenting. It has demonstrated safety and efficacy in most aspects of ischemic heart disease. Questions remain about optimal duration of therapy following deployment of drug-eluting stents.