Clinical update on the therapeutic use of clopidogrel: treatment of acute ST-segment elevation myocardial infarction (STEMI)

Abstract

The pathogenesis of ST-elevation myocardial infarction (STEMI) involves plaque disruption, platelet aggregation and intracoronary artery thrombus formation. Aspirin is the cornerstone of antiplatelet therapy in patients with STEMI, reducing the risk of recurrent myocardial infarction or death during the acute phase and long term by about one-quarter. Recent large randomized trials have demonstrated that the addition of clopidogrel to aspirin reduces the risk of major ischemic events by up to a further one-third in patients with STEMI treated with fibrinolytic therapy and undergoing percutaneous coronary intervention, with no significant increase in bleeding. Thus, dual antiplatelet therapy with the combination of clopidogrel and aspirin is becoming the new standard of care for the management of patients with STEMI.

Keywords:

• clopidogrel
• antiplatelet drugs
• acute coronary syndrome
• myocardial infarction

Acknowledgements

Dr Tran is the recipient of the Schering/Haematology Society of Australia & New Zealand Young Investigator Scholarship for 2006. Dr Mehta holds a New Investigator Award from the Canadian Institutes of Health Research. Dr Eikelboom holds a Tier II Canada Research Chair in Cardiovascular Medicine from the Canadian Institutes of Health Research.

Disclosures

Dr John W Eikelboom has received honoraria and/or research grants from Bayer, GSK, McNeil Pharmaceuticals, Pfizer, Sanofi-Aventis, Thrombovision, and Ventracor. Dr Shamir R Mehta has received research grant support via the Population Health Research Institute, Hamilton Health Sciences and McMaster University from Sanofi-Aventis, GSK and Bristol Myers Squibb. He has also received honoraria from Sanofi-Aventis, Bristol Myers Squibb, McNeil Johnson and Johnson, GSK, Eli Lilly, and AstraZeneca