A platelet Adenosine diphosphate receptor inhibitor.
Clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi-Aventis) is a prodrug requiring hepatic metabolism by cytochrome P450 (CYP) isoenzymes to generate an active metabolite that is responsible for irreversible blocking of its target, the platelet adenosine diphosphate (ADP) P2Y12 receptor. Numerous investigations have demonstrated a broad interindividual variability in clopidogrel-induced antiplatelet effects. Notably, patients with high on-treatment platelet reactivity (HPR) have an increased risk of recurrent ischemic events, including stent thrombosis. Genetic and environmental factors modulating hepatic metabolism of clopidogrel have shown to significantly contribute to these findings.
○ Coil embolization of wide-neck cerebral aneurysms where stent will be used
○ Therapeutic occlusion of large arteries (often with a second antiplatelet agent)
● Subacute management of procedural complications (alone or in combination with a second agent)
○ Parent artery coil herniations
○ Thrombus or clot on coil phenomena
○ In-stent thrombus (may be more effective than other agents).
75 mg PO daily. Start 5 days prior to the actual procedure because there is a 3–7 days latency period to full therapeutic effect.
LD: 300 mg PO, if there was no time to achieve therapeutic e ect over a course of days. A thera- peutic e ect can usually be achieved within 2 to 3 hours of LD.