WHAT IS THE ROLE OF CLOPIDOGREL IN CV DISEASE?
Clopidogrel is approved in the United States for reduction of atherothrombotic events in patients with recent MI, recent stroke, established peripheral arterial disease, or acute coronary syndrome (4). Although guidelines suggest clopidogrel as an alternative to aspirin for patients with unstable angina or non-ST-segment elevation MI who are intolerant of aspirin (5), clopidogrel is used primarily in combination with low-dose aspirin. Several randomized trials in patients with acute coronary syndrome or atrial fibrillation have shown that clopidogrel plus aspirin produces small but significant relative risk (RR) reductions of ~10–20% in CV events compared with aspirin alone (6,7,8). Current guidelines recommend clopidogrel plus aspirin for ≥1 month after a bare metal coronary artery stent, ≥1 year after a drug-eluting stent, ≥1 month and ideally 1 year after unstable angina or non-ST-elevation MI managed without intervention, and 1 year after ST-elevation MI (5,9,10). As dual antiplate
