Sparrow Hospital, Michigan State University, Lansing, USA.
Expert Opin Drug Saf. 2011 Jan;10(1):85-95. doi: 10.1517/14740338.2011.532485. Epub 2010 Nov 20.
Clopidogrel is an antiplatelet prodrug widely used in acute coronary syndromes and after intravascular stent placement. Acute or chronic use can cause bleeding, a major adverse effect, which can lead to drug discontinuation or noncompliance with therapy.
The mechanism of action of clopidogrel, safety of different loading doses of clopidogrel, its use as a solitary antiplatelet agent and concomitant use with other antiplatelet agents such as aspirin and warfarin are discussed. Thrombotic thrombocytopenic purpura, a rare but important adverse event, has also been reviewed. Literature searches including randomized controlled trials were conducted in Medline.
Clinicians will be able to understand the safety profile of using different doses of clopidogrel and the incidence of bleeding when used alone or in combination with other antiplatelet agents.
Compared to aspirin, clopidogrel when taken alone causes less severe bleeding and less intracranial hemorrhage. Higher loading dose of clopidogrel is associated with increased bleeding. When combined with other antiplatelet agents, risk of bleeding increases, but like any other drug, the risks have to be weighed against potential benefits.
氯吡格雷是一种广泛应用于急性冠状动脉综合征和血管内支架放置后的抗血小板前体药物。急性或慢性使用可能导致出血，这是一种主要的不良反应，可能导致药物停用或治疗不依从。
讨论了氯吡格雷的作用机制、不同负荷剂量氯吡格雷的安全性、其作为单一抗血小板药物的应用以及与阿司匹林和华法林等其他抗血小板药物的联合应用。还回顾了一种罕见但重要的不良反应——血栓性血小板减少性紫癜。在 Medline 中进行了包括随机对照试验在内的文献检索。
临床医生将能够了解使用不同剂量的氯吡格雷的安全性概况，以及单独使用或与其他抗血小板药物联合使用时出血的发生率。
与阿司匹林相比，氯吡格雷单独使用时引起的出血不那么严重，颅内出血也较少。较高的氯吡格雷负荷剂量与出血增加有关。与其他抗血小板药物联合使用时，出血风险增加，但与任何其他药物一样，必须权衡风险与潜在益处。
