Optimizing long-term dual aspirin/clopidogrel therapy in acute coronary syndromes: When does the risk outweigh the benefit?

Collet, Jean‐Philippe; Montalescot, Gilles

doi:10.1016/j.ijcard.2008.12.202

Cited by 7 publications

(3 citation statements)

References 59 publications

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“…Furthermore, significantly more clopidogrel-treated subjects were included in the present study. Another reason for the potentially longer exposure times compared with the previous study is that in recent years guidelines have changed so that a treatment duration of up to 1 year is now recommended for patients with ACS and those with drug-eluting stents, and of more than 1 year for patients with a high risk of thromboembolic events [22].…”

Section: Discussionmentioning

confidence: 99%

Clopidogrel and the risk of osteoporotic fractures: a nationwide cohort study

Jørgensen

Grove

Schwarz

et al. 2012

Journal of Internal Medicine

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Abstract. Jørgensen NR, Grove EL, Schwarz P, Vestergaard P (Research Center for Aging and Osteoporosis, Copenhagen University Hospital Glostrup; Aarhus University Hospital, Skejby; University of Copenhagen, Copenhagen; The Osteoporosis Clinic, Aarhus University Hospital, Denmark). Clopidogrel and the risk of osteoporotic fractures: a nationwide cohort study. J Intern Med 2012; 272: 385-393.Objectives: The P2Y 12 inhibitor clopidogrel inhibits platelet aggregation and is used in the treatment and prevention of coronary artery disease. It is widely used and, in combination with acetylsalicylic acid, is the standard of care for acute coronary syndrome and percutaneous coronary intervention. The mode of action of clopidogrel involves pathways that are important to the metabolic activity in bone cells, although to our knowledge whether P2Y 12 receptors are involved in the regulation of bone metabolism has not yet been investigated. Therefore, the objective of the present study was to investigate the association between clopidogrel use and risk of fractures. Methods:We investigated the association between clopidogrel use and fracture incidence in a nationwide cohort study within the Danish population of approximately 5.3 million individuals. All patients who were prescribed clopidogrel during the years 1996-2008 were included in the study (n = 77 503), and three nonusers were randomly selected, matched for age and gender (n = 232 510), for each clopidogrel-treated subject.Results: Treatment with clopidogrel was associated with both increased overall fracture risk and increased risk of osteoporotic fractures, especially in subjects with a treatment duration of more than 1 year. However, individuals with low exposure to clopidogrel (<0.01 defined daily dose) had a lower risk of fracture than never users.Conclusions: Use of the P2Y 12 inhibitor clopidogrel is associated with risk of fractures. There seems to be a biphasic relation so that lower doses are associated with decreased fracture risk, whereas higher doses (recommended dose range) are associated with increased risk. More studies are warranted to determine the potential in vivo effect of platelet aggregation inhibitors on bone metabolism.

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Section: Discussionmentioning

confidence: 99%

Clopidogrel and the risk of osteoporotic fractures: a nationwide cohort study

Jørgensen

Grove

Schwarz

et al. 2012

Journal of Internal Medicine

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“…Several factors may account for this longer than the expected duration of treatment including overlapping indications, comorbidities or other surgical procedures. Given that HD patients are at risk of thrombosis, some reports have also suggested that extended DAPT beyond the typical one‐year treatment could be beneficial in HD patients, but this will require a constant re‐evaluation of the patients’ bleeding risk 12,39,40 …”

Section: Discussionmentioning

confidence: 99%

“…Given that HD patients are at risk of thrombosis, some reports have also suggested that extended DAPT beyond the typical one-year treatment could be beneficial in HD patients, but this will require a constant re-evaluation of the patients' bleeding risk. 12,39,40 Despite screening all patients from our outpatient HD unit, this study has some limitations. The sample size of this single HD unit may not represent the true prevalence of ATT use in other HD cohorts.…”

Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

A retrospective study of antithrombotic therapy use in an outpatient haemodialysis unit

Dizon

Battistella

2021

J Clin Pharm Ther

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What is known and Objective: Patients on haemodialysis (HD) are at increased risk of both bleeding and thrombotic events, due to comorbidities and nature of dialysis treatment. However, there is a lack of research on evidence-based treatment strategies and prescribing patterns for antithrombotic therapies (ATT) in this population. To characterize ATT use and its main indications in an outpatient HD unit.Methods: A single-centre retrospective chart review was conducted in a Toronto outpatient HD unit (n = 329

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