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JOSHUA SULLIVAN, PHARM.D., is Hospital Pharmacy Practice Resident, Veterans Affairs Medical Center, Memphis, TN; at the time of writing he was a pharmacy student, University of Tennessee Health Science Center, Memphis. NASEEM AMARSHI, PHARM.D., is Medication Reconciliation Pharmacist, Central Arkansas Veterans Health-care System, Little Rock; at the time of writing she was Director of Drug Information and Associate Professor, University of Tennessee, Memphis.

Address correspondence to Dr. Sullivan at the Veterans Affairs Hospital Pharmacy, 1030 Jefferson Avenue, Memphis, TN 38104 (j007ws99{at}aol.com).

Purpose. Dual antiplatelet therapy with clopidogrel and aspirin is reviewed. Summary. Several studies have evaluated the effectiveness of clopidogrel, aspirin, or the combination of these agents in a variety of patient populations. The results of these studies have helped determine the role of clopidogrel and aspirin in evidence-based medicine. Investigators in the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance trial concluded that patients with multiple atherothrombotic risk factors who have stable cardiovascular disease (CVD) or no history of CVD or documented vascular disease should not receive combination clopidogrel and aspirin due to an increase in death. Patients with established vascular disease being treated with clopidogrel and aspirin may benefit from the combination through a reduction in the rate of myocardial infarction, stroke, or death from cardiovascular causes. The combination should not be used longer than one year since the benefits past one year have not been established by clinical trials, though consideration for longer treatment may be warranted in patients with stent implantation. One of the inherent risks associated with using clopidogrel and aspirin is the risk for increased bleeding. If a patient is started on combination therapy, it is imperative to monitor for signs and symptoms of bleeding. Conclusion. Dual antiplatelet therapy with clopidogrel and aspirin should be used in certain patients, such as those with any type of acute coronary syndrome or stent implantation, if there are no contraindications to combined therapy. The risk of bleeding should be considered in patients receiving the combination. Index terms: Aspirin; Clopidogrel; Combined therapy; Coronary artery bypass; Hemorrhage; Platelet aggregation inhibitors; Toxicity

 

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