Clopidogrel and the prevention of cardiovascular events

Platelet activation and subsequent aggregation are implicated in most cardiovascular events. The oral agent, clopidogrel, is an irreversible inhibitor of the ADP-mediated pathway of platelet activation. It is licensed for secondary prevention of atherothrombotic events in patients suffering from myocardial infarction and acute coronary syndromes, but is also used for a number of off-label indications in particular, the prevention of stent thrombosis following percutaneous coronary intervention. The evidence base to support its use alone or in combination with aspirin therapy for these indications is presented here, alongside some of the key issues and problems related to clopidogrel use in clinical practice, with a specific focus on when treatment should be started, the use of loading doses and the optimal durations of therapy.