COMPARISON OF EFFECT OF LOCALLY AVAILABLE BRANDS OF CLOPIDOGREL ON PLATELET AGGREGATION IN PATIENTS WITH CORONARY ARTERY DISEASE
AbstractBackground: Anticoagulant effect of clopidogrel is of utmost importance in coronary artery disease,especially in prevention of coronary stent thrombosis. Recently, many new local brands of clopidogrelhave been launched, with unknown efficacy. This study was conducted with the aim to compare twolocally prepared clopidogrel brands, in terms of the effect of a loading dose of 600 mg on inhibition ofplatelet aggregation in patients with coronary artery disease. Methods: This was a double blindrandomised study. Sample population consisting of 35 patients, were admitted at Lady ReadingHospital, Peshawar, for the management of coronary artery disease. Baseline platelet aggregation of allthese patients was measured. These patients were divided in two groups randomly. Group-A consistingof 18 patients was given brand ‘A’ clopidogrel 600 mg, while Group-B consisting of 17 patients wasgive brand ‘B’ of clopidogrel 600 mg. The platelet aggregation of both groups was then measured atbaseline, and at 2, 4, and 6 hours after taking the loading dose of 600 mg. Results: Platelet aggregationtime at baseline in Group-A was 2.61±2.28 sec. and in Group-B it was 2.24±1.52 sec. (p=0.57). After 2hours of clopidogrel administration in Group-A the platelet aggregation time was 1.44±1.58 sec. and inGroup-B it was 1.53±1.107 sec. (p=0.85). Platelet aggregation time after 4 hours in Group-A was0.28±0.57 sec. and in Group-B 1.06±1.03 sec. (p=0.009), and after 6 hours it was 0.00±0.00 sec. inGroup-A and in Group-B it was 0.59±0.71 sec. (p=0.001). Conclusion: The two brands of clopidogrelhad a significant difference in their effect on inhibition of platelet aggregation. Different brands ofclopidogrel may not be equally effective.Keywords: Platelet Aggregation, Clopidogrel, Coronary Artery Disease
Sabatine MS, McCabe CH, Cannon CP. Design and rationale
of clopidogrel as adjunctive reperfusion therapy
(CLARITY)- thrombosis in myocardial infarctio (TIMI) 28
trial. Am Heart J 2005;149:227–33.
Quinn MJ, Fitzgerald DJ. Ticlopidine and clopidogrel.
George CM, Kayser Sr, Adler DS. Thromboembolic disease
in; Herfindal ET, Hirshman, jl, Eds. Clinical pharmacy and
therapeutics. 6th edition. Baltimore MD: Williams and
Diaz Linares M, Rodvold KA, Friedenberg WR. Coagulation
disorders. In; Dipiro jt, Talbert RT, Eds Pharmacotherapy, a
Pathophysiology Approach 4th ed. Stamford: Appletion and
Easton JD. Evidence with Antiplatelet Therapy and ADPreceptor Antagonist. Cerebrovasc Dis 2003;16(Suppl 1):20–
CAPRIE steering committee. A randomized, blinded, trial of
clopidogrel versus aspirin at risk of ischemic events
(CAPRIE). Lancet 1996;348:1329–39.
Antiplatelet Trialist Collaboration. Collaborative overview of
randomized trials of antiplatelet therapy, Prevention of death,
myocardial infarction and stroke by prolonged antiplatelet
therapy in various categories of patients. BMJ 1994;308:81–
The Clopidogrel in Unstable Angina to Prevent Recurrent
Events Trial Investigators. Effects of clopidogrel in addition
to aspirin in patients with Ischemic heart diseases without
ST-segment elevation. N Engl J Med 2001;345:494–502.
Born GVR. Quantitative investigations into the aggregation
of blood platelets. J. Physiol Lond 1962;162:67–8.
Clopidogrel product monograph, May 2003.
Iris M, Melchior S, Silja R. Effect of High Loading Dose of
Clopidogrel on Platelet Functions in Patients Undergoing
Coronary Stent Placement. Heart 2001;85:92–3.
Iris M, Felicitas B, Christian S. Prevalence of clopidogrel
non-responders among patients with stable angina pectoris
scheduled for elective coronary stent placement. Thromb
Yan BP, Clark DJ, Ajani AE. Oral antiplatelet therapy and
percutaneous coronary intervention. Expert Opin
Bertrand ME, Rupprecht H-J, Urban P. Double-blind study of
the safety of clopidogrel with and without a loading dose in
combination with aspirin compared with ticlopidine in
combination with aspirin after coronary stenting: the
clopidogrel aspirin stent international cooperative study
(CLASSICS). Circulation 2000;102:624–9.
Yusuf S, Zhao F, Mehta SR. For the Clopidogrel in Unstable
Angina to Prevent Recurrent Events Trial Investigators.
Effects of clopidogrel in addition to aspirin in patients with
acute coronary syndromes without ST-segment elevation. N
Engl J Med 2001;345:494–502.
Mehta SR, Yusuf S, Peters RJG. For the Clopidogrel in
Unstable angina to prevent Recurrent Events trial (CURE)
Investigators. Effects of pretreatment with clopidogrel and
aspirin followed by long-term therapy in patients undergoing
percutaneous coronary intervention: the PCI-CURE study.
Steven R. Steinhubl, Peter B. For the CREDO Investigators
Early and Sustained Dual Oral Antiplatelet Therapy
Following Percutaneous Coronary Intervention: A
Randomized Controlled Trial. JAMA 2002;288:2411–20.
COMMIT/CCS-2 (Clopidogrel and Metoprolol in
Myocardial Infarction Trial), ACC's 54 Annual Scientific
Sessions in Orlando, Florida, 9 March 2005.
Marc SS, Christopher PC, Michael GC. CLARITY-TIMI 28
(Clopidogrel as adjunctive reperfusion therapy-thrombolysis
in myocardial infarction study 28). N Engl J Med
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.