The use of clopidogrel in acute coronary syndrome

Despite major improvements in the management of acute coronary syndromes, appreciable risks for mortality and morbidity remain. Platelet adhesion and aggregation play the key role in the pathophysiology of acute coronary syndromes. Antiplatelet therapy with aspirin has proved to be of great benefit to reduce cardiovascular events and mortality. Having a distinct mechanism to decrease platelet adhesion and aggregation, clopidogrel has also become a common component of therapeutic regimens for acute coronary syndrome. Consistent findings from numerous trials show that dual antiplatelet therapy with aspirin and clopidogrel is superior to aspirin alone for the prevention of major cardiac events after percutaneous coronary intervention. The guidelines for the management of unstable angina pectoris and non-ST elevation myocardial infarction recommend to add clopidogrel to aspirin. These have led to further studies to determine the effect of clopidogrel in the therapy of ST elevation myocardial infarction and two recent randomized trials have shown the beneficial effect of clopidogrel in this setting. In spite of the accumulated evidence favoring clopidogrel in various cardiac diseases, conflicting issues exist regarding its clinical use, requiring further studies for the appropriate use of clopidogrel. In this review, the role of clopidogrel was examined in the management of acute coronary syndrome.