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Latest & greatest articles for clopidogrel
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Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial Dual antiplatelet therapy with clopidogrel plus acetylsalicylic acid (ASA) is superior to ASA alone in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention. We sought to determine whether clopidogrel plus ASA conferred benefit on limb outcomes over ASA alone in patients undergoing below-knee bypass (...) grafting.Patients undergoing unilateral, below-knee bypass graft for atherosclerotic peripheral arterial disease (PAD) were enrolled 2 to 4 days after surgery and were randomly assigned to clopidogrel 75 mg/day plus ASA 75 to 100 mg/day or placebo plus ASA 75 to 100 mg/day for 6 to 24 months. The primary efficacy endpoint was a composite of index-graft occlusion or revascularization, above-ankle amputation of the affected limb, or death. The primary safety endpoint was severe bleeding (Global Utilization
Interaction of clopidogrel and omeprazole. 21067412 2010 11 30 2018 12 01 1533-4406 363 20 2010 Nov 11 The New England journal of medicine N. Engl. J. Med. Interaction of clopidogrel and omeprazole. 1977 10.1056/NEJMc1012022 Southworth Mary Ross MR Temple Robert R eng Letter Comment United States N Engl J Med 0255562 0028-4793 0 Platelet Aggregation Inhibitors 0 Proton Pump Inhibitors A74586SNO7 Clopidogrel KG60484QX9 Omeprazole OM90ZUW7M1 Ticlopidine AIM IM N Engl J Med. 2010 Nov 11;363(20 (...) ):1909-17 20925534 Cardiovascular Diseases epidemiology prevention & control Clopidogrel Coronary Artery Disease drug therapy Drug Interactions Drug Therapy, Combination Gastrointestinal Hemorrhage prevention & control Humans Omeprazole pharmacology therapeutic use Platelet Aggregation Inhibitors therapeutic use Proton Pump Inhibitors pharmacology therapeutic use Ticlopidine analogs & derivatives therapeutic use 2010 11 12 6 0 2010 11 12 6 0 2010 12 14 6 0 ppublish 21067412 10.1056/NEJMc1012022
Reduced-function CYP2C19 genotype and risk of adverse clinical outcomes among patients treated with clopidogrel predominantly for PCI: a meta-analysis. Clopidogrel, one of the most commonly prescribed medications, is a prodrug requiring CYP450 biotransformation. Data suggest its pharmacologic effect varies based on CYP2C19 genotype, but there is uncertainty regarding the clinical risk imparted by specific genotypes.To define the risk of major adverse cardiovascular outcomes among carriers of 1 (...) (≈ 26% prevalence in whites) and carriers of 2 (≈ 2% prevalence in whites) reduced-function CYP2C19 genetic variants in patients treated with clopidogrel.A literature search was conducted (January 2000-August 2010) in MEDLINE, Cochrane Database of Systematic Reviews, and EMBASE. Genetic studies were included in which clopidogrel was initiated in predominantly invasively managed patients in a manner consistent with the current guideline recommendations and in which clinical outcomes were
Effect of clopidogrel on the rate and functional severity of stroke among high vascular risk patients: a prespecified substudy of the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA) trial Disabling stroke is costly and considered by some patients a fate worse than death. We aimed to determine whether clopidogrel reduces the rate and functional severity of stroke among high vascular risk patients, including patients with previous (...) transient ischemic attack or ischemic stroke, who were enrolled in the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA) trial.We randomly assigned 15,603 high vascular risk patients to receive clopidogrel (75 mg daily) or placebo in addition to background acetylsalicylic acid and followed them for a median of 28 months. The main outcome of this prespecified substudy was the functional severity of stroke outcome events as measured by the modified
Clopidogrel (Plavix) and Proton Pump Inhibitors: An Update on the Potential Drug Interaction Clopidogrel (Plavix®) and Proton Pump Inhibitors: An Update on the Potential Drug Interaction – Clinical Correlations Search Clopidogrel (Plavix®) and Proton Pump Inhibitors: An Update on the Potential Drug Interaction July 28, 2010 5 min read By Antony Q. Pham, Pharm.D. and Reena M. Tejura, Pharm.D. Faculty Peer Reviewed Recent publications have described a potential drug interaction between (...) clopidogrel (Plavix®) and proton pump inhibitors (PPIs). Several retrospective studies have concluded that the use of PPIs can lower the effectiveness of clopidogrel and as a result, increase the possibility of cardiovascular events. Limited data from prospective trials have yet to show a clinical significance from this potential interaction. The Food and Drug Administration (FDA) released an early communication about the ongoing safety review of clopidogrel and omeprazole on January 26, 2009. Over
Incidence of Dyspnea and Assessment of Cardiac and Pulmonary Function in Patients With Stable Coronary Artery Disease Receiving Ticagrelor, Clopidogrel, or Placebo in the ONSET/OFFSET Study We prospectively assessed cardiac and pulmonary function in patients with stable coronary artery disease (CAD) treated with ticagrelor, clopidogrel, or placebo in the ONSET/OFFSET (A Multi-Centre Randomised, Double-Blind, Double-Dummy Parallel Group Study of the Onset and Offset of Antiplatelet Effects (...) of AZD6140 Compared With Clopidogrel and Placebo With Aspirin as Background Therapy in Patients With Stable Coronary Artery Disease) study.Ticagrelor reduces cardiovascular events more effectively than clopidogrel in patients with acute coronary syndromes. Dyspnea develops in some patients treated with ticagrelor, and it is not known whether this is associated with changes in cardiac or pulmonary function.In all, 123 stable aspirin-treated CAD patients randomly received either ticagrelor (180 mg load
Risk of adverse outcomes in Taiwan associated with concomitant use of clopidogrel and proton pump inhibitors in patients who received percutaneous coronary intervention Recent studies have suggested that proton pump inhibitors (PPIs) might reduce the inhibitory effect of clopidogrel on platelet aggregation, possibly through inhibition of the hepatic cytochrome P450 2C19 (CYP2C19) isoenzyme. The prevalence of CYP2C19 loss-of-function alleles is much greater among East Asians than among other (...) populations. Thus, potential drug interactions might be more apparent. Therefore, we conducted a nationwide, population-based study using the Taiwan National Health Insurance database. We identified 3,278 patients (mean age 65.9 +/- 11.9 years, 71.9% men) with coronary artery disease who had taken clopidogrel after percutaneous coronary intervention from the 1 million sampling cohort data set since January 1, 2002. Of the 3,278 patients, 572 had received concomitant PPIs for underlying gastrointestinal
Adding clopidogrel to standard therapy for acute myocardial infarction. BestBets: Adding clopidogrel to standard therapy for acute myocardial infarction. Adding clopidogrel to standard therapy for acute myocardial infarction. Report By: Kate Rotheray - Visiting Scholar Search checked by Giles Cattermole - Assistant Professor Institution: Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Date Submitted: 22nd October 2009 Date Completed: 23rd March 2010 Last Modified: 14th (...) April 2010 Status: Green (complete) Three Part Question In [patients with acute ST-elevation MI] is [clopidogrel plus aspirin better than aspirin alone] at [reducing morbidity and mortality]? Clinical Scenario A 60 year old man presents to the Emergency Department (ED) with chest pain. The ECG shows an ST elevation MI. You give him oxygen, nitrates, aspirin and morphine and also start thrombolysis. You wonder whether giving him clopidogrel as well would be beneficial. Search Strategy (OVID interface
When Clopidogrel Fails… When Clopidogrel Fails… – Clinical Correlations Search When Clopidogrel Fails… March 10, 2010 3 min read Marisa Mizus Faculty peer reviewed Clopidogrel ( Plavix ) has been the standard of care for patients with coronary artery disease following percutaneous coronary intervention (PCI) for the past decade. Although it is a successful antiplatelet treatment in many patients, like any hero, it has a weakness: formation of its active metabolite depends on two hepatic (...) cytochrome P450 (CYP450)-dependent steps. Clopidogrel resistance, or non-response, is correlated with an increased risk of major adverse cardiovascular events, including reinfarction and stent thrombosis.(1) It is often unclear why a patient does not respond to clopidogrel, although there is speculation that clopidogrel resistance results from the attenuating effects of proton pump inhibitors (PPIs) and CYP450 reduced function polymorphisms.(2) Patients showing inadequate platelet response to clopidogrel
Cost-Effectiveness of Prasugrel Versus Clopidogrel in Patients With Acute Coronary Syndromes and Planned Percutaneous Coronary Intervention. Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction TRITON-TIMI 38 In patients with acute coronary syndromes and planned percutaneous coronary intervention, the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38 (...) ) demonstrated that treatment with prasugrel versus clopidogrel was associated with reduced rates of cardiovascular death, MI, or stroke and an increased risk of major bleeding. We evaluated the cost-effectiveness of prasugrel versus clopidogrel from the perspective of the US healthcare system by using data from TRITON-TIMI 38.Detailed resource use data were prospectively collected for all patients recruited from 8 countries (United States, Australia, Canada, Germany, Italy, Spain, United Kingdom, and France
The Safety and Efficacy of Clopidogrel in Children with Heart Disease: A Systematic Review "The Safety and Efficacy of Clopidogrel in Children with Heart Disease:" by Kristen Schmiedeskamp < > > > > > Title Author Date of Graduation 12-2010 Degree Type Capstone Project Degree Name Master of Science in Physician Assistant Studies First Advisor Robert P. Rosenow, Pharm.D., O.D. Rights . Abstract Background: Clopidogrel, an oral antiplatelet, has been used off-label in pediatric patients at risk (...) for thrombosis, including those with heart disease, for more than a decade. While numerous clinical trials in adults have resulted in the formation of comprehensive management guidelines, considerably less is known about the safety and efficacy of clopidogrel use in children. Method: An exhaustive literature search was performed using PubMed, Web of Science, Cochrane, Medline, CINAHL and International Pharmaceutical Abstracts. The keywords searched included “clopidogrel”, “child”, “teen”, “young”, “pediatric
Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study. Variation in and irreversibility of platelet inhibition with clopidogrel has led to controversy about its optimum dose and timing of administration in patients with acute coronary syndromes. We compared ticagrelor, a more potent reversible P2Y12 inhibitor with clopidogrel in such patients.At randomisation, an invasive strategy was planned (...) for 13 408 (72.0%) of 18 624 patients hospitalised for acute coronary syndromes (with or without ST elevation). In a double-blind, double-dummy study, patients were randomly assigned in a one-to-one ratio to ticagrelor and placebo (180 mg loading dose followed by 90 mg twice a day), or to clopidogrel and placebo (300-600 mg loading dose or continuation with maintenance dose followed by 75 mg per day) for 6-12 months. All patients were given aspirin. The primary composite endpoint was cardiovascular
Effects of CYP2C19 genotype on outcomes of clopidogrel treatment. It has been suggested that clopidogrel may be less effective in reducing the rate of cardiovascular events among persons who are carriers of loss-of-function CYP2C19 alleles that are associated with reduced conversion of clopidogrel to its active metabolite.We genotyped patients from two large, randomized trials that showed that clopidogrel, as compared with placebo, reduced the rate of cardiovascular events (the primary efficacy (...) outcome) among patients with acute coronary syndromes and among patients with atrial fibrillation. Patients were genotyped for three single-nucleotide polymorphisms (*2, *3, *17) that define the major CYP2C19 alleles.Among 5059 genotyped patients with acute coronary syndromes, clopidogrel as compared with placebo significantly reduced the rate of the primary efficacy outcome, irrespective of the genetically determined metabolizer phenotype (P=0.12 for heterogeneity). The effect of clopidogrel
Clopidogrel with or without omeprazole in coronary artery disease. Gastrointestinal complications are an important problem of antithrombotic therapy. Proton-pump inhibitors (PPIs) are believed to decrease the risk of such complications, though no randomized trial has proved this in patients receiving dual antiplatelet therapy. Recently, concerns have been raised about the potential for PPIs to blunt the efficacy of clopidogrel.We randomly assigned patients with an indication for dual (...) antiplatelet therapy to receive clopidogrel in combination with either omeprazole or placebo, in addition to aspirin. The primary gastrointestinal end point was a composite of overt or occult bleeding, symptomatic gastroduodenal ulcers or erosions, obstruction, or perforation. The primary cardiovascular end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction, revascularization, or stroke. The trial was terminated prematurely when the sponsor lost financing.We planned
Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Clopidogrel and aspirin are the most commonly used antiplatelet therapies for percutaneous coronary intervention (PCI). We assessed the effect of various clopidogrel and aspirin regimens in prevention of major cardiovascular events and stent thrombosis in patients undergoing (...) PCI.The CURRENT-OASIS 7 trial was undertaken in 597 centres in 39 countries. 25,086 individuals with acute coronary syndromes and intended early PCI were randomly assigned to double-dose (600 mg on day 1, 150 mg on days 2-7, then 75 mg daily) versus standard-dose (300 mg on day 1 then 75 mg daily) clopidogrel, and high-dose (300-325 mg daily) versus low-dose (75-100 mg daily) aspirin. Randomisation was done with a 24 h computerised central automated voice response system. The clopidogrel dose
Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. Clopidogrel and aspirin are widely used for patients with acute coronary syndromes and those undergoing percutaneous coronary intervention (PCI). However, evidence-based guidelines for dosing have not been established for either agent.We randomly assigned, in a 2-by-2 factorial design, 25,086 patients with an acute coronary syndrome who were referred for an invasive strategy to either double-dose clopidogrel (a 600-mg (...) loading dose on day 1, followed by 150 mg daily for 6 days and 75 mg daily thereafter) or standard-dose clopidogrel (a 300-mg loading dose and 75 mg daily thereafter) and either higher-dose aspirin (300 to 325 mg daily) or lower-dose aspirin (75 to 100 mg daily). The primary outcome was cardiovascular death, myocardial infarction, or stroke at 30 days.The primary outcome occurred in 4.2% of patients assigned to double-dose clopidogrel as compared with 4.4% assigned to standard-dose clopidogrel (hazard
Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events National Institute for Health and Clinical Excellence Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA (...) database. Citation National Institute for Health and Clinical Excellence. Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events. London: National Institute for Health and Clinical Excellence (NICE). Technology Appraisal Guidance 210. 2010 Authors' conclusions This guidance applies to people who have had an occlusive vascular event, or who have established peripheral arterial disease. For people who have had a myocardial infarction, this guidance follows on from
Clopidogrel compared with other antiplatelet agents for secondary prevention of vascular events in adults undergoing percutaneous coronary intervention: clinical and cost-effectiveness analyses Clopidogrel compared with other antiplatelet agents for secondary prevention of vascular events in adults undergoing percutaneous coronary intervention: clinical and cost-effectiveness analyses Clopidogrel compared with other antiplatelet agents for secondary prevention of vascular events in adults (...) M. Clopidogrel compared with other antiplatelet agents for secondary prevention of vascular events in adults undergoing percutaneous coronary intervention: clinical and cost-effectiveness analyses. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH). Technology report no 131. 2010 Authors' conclusions The estimates of relative effectiveness for clopidogrel and ticlopidine with ASA suggest that the optimal therapeutic choice is unclear. Clopidogrel and ticlopidine are at least