Hematology and Oncology Book

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ClopidogrelAka: Plavix, Thienopyridine, Thiophene, Prasugrel, Effient

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  1. Mechanism: Thienopyridine Class
    1. Blocks Platelet ADP
    2. Inhibits platelet aggregation
  2. Indications
    1. Cerebrovascular Accident Prevention
    2. Coronary Artery Disease Prevention
  3. Preparations
    1. Clopidogrel (Plavix)
    2. Prasugrel (Effient)
      1. Pending FDA approval in Summer 2008
      2. More effective than Plavix in cardiovascular event reduction
      3. Higher risk of bleeding than Plavix in age >75 years, weight <60 kg, CVA history
      4. Wiviott (2007) N Engl J Med 357(20):2001
  4. Advantages: Clopidogrel
    1. Less adverse effects than Ticlid
    2. Less GI Bleeding than Aspirin
      1. Option if GI Bleeding occurs with Aspirin
      2. Switch to Plavix does not prevent recurrent GI Bleed
        1. GI Bleed occurs in 8% of those switched to Plavix
        2. Consider adding PPI to Aspirin instead of Plavix
  5. Disadvantages
    1. Expensive ($125/month)
  6. Dosing
    1. Plavix 75 mg PO qd
  7. Protocol: Perioperative
    1. Stop 7 days before surgery
  8. Precautions
    1. Mortality doubles in Acute Coronary Syndrome patients in first 90 days after stopping Plavix
      1. Consider tapering off by taking every other day for 2-3 weeks
      2. Conitinue Aspirin after stopping Plavix
      3. Ho (2008) JAMA 299(5):532

clopidogrel (C0070166)

Definition (CSP)inhibits platelet aggregation
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHC055162
Englishclopidogrel, CLOPIDOGREL PREPARATION
Spanishclopidogrel
Parent ConceptsPlatelet Aggregation Inhibitors (C0032177), Thiophene (C0599532), Antiplatelet Agents (C0085826), Ticlopidine (C0040207), Drug allergen (C1320237)
SourcesCSP, MSH, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Thiophene (C0599532)

Definition (CSP)5-membered aromatic ring structure with a sulfur heteroatom.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
Englishthiofuran, thiole, Thiophene
Spanishtiofeno
Parent Conceptssulfurous heterocyclic compound (C0597542), Mercaptan compound (C0301116)
SourcesCSP, LCH, MTH, RXNORM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Plavix (C0633084)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHC055162
EnglishPlavix
SourcesMSH, NCI, PDQ, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)



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