engleski

Clopidogrel in Cerebrovascular Disease

Clopidogrel is a newer thienopyridine derivate that is an efficient antiplatelet drug. It blocks irreversibly ADP receptors on platelet surface therefore blocking adenosine diphosphate pathway of platelet aggregation. In PLUTO-Stroke study it was shown that combined administration of clopidogrel and acetylsalicylic acid during one month significantly more strongly inhibits platelet aggregation than administration of acetylsalicylic acid alone. In CAPRIE study the effect of clopidogrel (75 mg daily) and acetylsalicylic acid (325 mg daily) in reducing the incidence of ischemic stroke, myocardial infarction and peripheral artery disease was analyzed. Significant reduction of incidence (8.7%) of these vascular events was found in clopidogrel group. Post hoc analysis showed that patients in CAPRIE study that had previous symptomatic atherosclerotic disease had high incidence of recurrent ischemic events. Absolute benefit of clopidogrel versus acetylsalicylic acid was especially pronounced in these high-risk patients. In CURE study 12, 562 patients with acute coronary syndrome were using clopidogrel 300 mg on the first day, and 75 mg daily afterwards during 3 months to 1 year with the usual therapy, most often acetylsalicylic acid. Results of this study showed that in patients with previous stroke the incidence of major vascular events reduced from 22.4% in the group with usual therapy to 17.9% in the group taking clopidogrel. Likewise, in patients without previous stroke the incidence of major vascular events was reduced frorn 11.0% in the group with usual therapy to 8.9% in the group taking clopidogrel. This study also showed that clopidogrel is very efificient in high-risk patients. In CARESS study patients with carotid artery stenosis greater than 50% and recent stroke or transient ischemic attack were using clopidagrel with acetylsalicylic acid and signiticant reduction of microemboli signals detected with transcranial Doppler sono raphy was recorded in comparison with patients using acetylsalicylic acid alone. Likewise, patients using clopidogrel with acetyisaiicylic acid had significantly less stroke, transient ische ic attacks and myocardial infarction. The incidence of bleeding was similar in both groups. Data from all these studies show that clopidogrel is significantly more efficient than acetylsalicylic acid. Clopidogrel is a drug af choice in stroke prevention for patients in whom acetylsalicylic acid is contraindicated, and who have acetylsalicylic acid side e ects. Clapidogrel is especially effective in highrisk patients.

Clopidogrel; cerebrovascular disease; CARESS; CAPRI

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