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Clopidogrel in the Management of Acute Coronary Syndromes: Indications, Results, Obstacles

Amsterdam, Ezra A. MD

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine: June 2009 - Volume 8 - Issue 2 - p 49-54
doi: 10.1097/HPC.0b013e31819a442a
Original Article

Atherothrombosis is the underlying pathology of the acute coronary syndromes (ACS), in which platelet activation plays a key role. Therefore, antiplatelet therapy is an essential component of guideline-recommended ACS management. Considerable evidence clearly demonstrates the benefits of the antiplatelet agent clopidogrel in reducing mortality, decreasing recurrent cardiovascular events, and increasing arterial patency in ACS patients. Despite this evidence, data from patient registries and clinical initiatives such as CRUSADE (Can Rapid stratification of Unstable angina Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association guidelines) and GRACE (Global Registry of Acute Coronary Events) indicate that clopidogrel is underused in patients with ACS. This is especially true for patients receiving conservative medical management, many of whom have significant risk for recurrent ischemic events. The purpose of this review is to compare “real-life” clopidogrel therapy with evidence-based guidelines, and to highlight clinical factors that drive clopidogrel implementation or provide barriers to its use in ACS patients.

From the Division of Cardiovascular Medicine, University of California (Davis) Medical Center, Sacramento, California.

Reprints: Ezra A. Amsterdam, MD, Lawrence J. Ellison Ambulatory Care Center, 4680 Y Street, Suite 0200, Sacramento, CA 95817. E-mail:

This manuscript was written and edited by the author, who takes full responsibility for its content.

© 2009 Lippincott Williams & Wilkins, Inc.