Clopidogrel is a thienopyridine antiplatelet drug used in thromboembolic disorders. It is an analogue of ticlopidine and acts by inhibiting adenosine diphosphate mediated platelet aggregation. It is given prophylactically as an alternative to aspirin in patients with atherosclerosis who are at risk of thromboembolic disorders such as myocardial infarction, peripheral arterial disease, and stroke. Clopidogrel is also used with aspirin in acute coronary syndromes, including acute myocardial infarction and unstable angina, and in coronary stenting. Clopidogrel is given orally as the bisulfate, but doses are expressed in terms of the base; 97.86 mg of clopidogrel bisulfate is equivalent to 75 mg of base. For the prophylaxis of thromboembolic events, the usual dose of clopidogrel is 75 mg once daily. In the management of acute ST-elevation myocardial infarction, clopidogrel is used with aspirin as an adjunct in medically-treated patients. It is given in a dose of 75 mg once daily; patients under 75 years of age may be given a loading dose of 300 mg. Treatment should be continued for at least 4 weeks. In the management of unstable angina and non-Qwave myocardial infarction, clopidogrel is used with aspirin as an adjunct to either medical or interventional treatment, including coronary stenting. A single loading dose of 300 mg is given, followed by 75 mg once daily.
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