Mohamed Rawy: Clinical Pearls of Clopidogrel
Mohamed Rawy, Hospital Pharmacist at Specialized Medical Center Hospital, shared on LinkedIn:
”Clinical Pearls of Clopidogrel (Plavix®)
- Irreversible P2Y12 inhibitor antithrombotic
- Loading dose of 600mg has a more rapid and peak effect than doses of 300mg and thus it is preferred to be administered before PCI
Patients with Known to be poor CYP2C19 metabolizer will have reduced effect of clopidogrel and should use another P2Y12 inhibitor
- Avoid concomitant administration with PPI except Pantoprazole or Dexlansoprazole or Rabeprazole
Preferred over prasugrel and ticagrelor in patients with HBR or in case of thrombocytopenia
Check algorithm approved by ESC for switching between P2Y12 inhibitors (Do not combine together)
- Has many approved indications like IHD , IS , PAD , TAVI
Alternative to Aspirin in cases of Essential thromcythemia or Kawasaki disease or polycythemia vera
Can be used as a part of TAT for patients with ACS and AF
Duration of DAPT depends on Ischemic and Bleeding risks
Can be used for ACS patients who has thrombocytopenia up to a platelet count of 30.000 cell/mm3
It should be withhold before cardiac surgery by 1-5 days and by 5 days if non cardiac surgery and restart ASAP (≤24 hours) postoperative
- Bleeding can be reversed by administration of Desmopressin
Can be used during pregnancy or breastfeeding if ischemic event occurs
For full information kindly read the monograph (Drugs of ICU)”
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