Evolving role of clopidogrel in acute coronary syndromes

Abstract

Antiplatelets constitute a cornerstone in thetreatment of acute coronary syndromes(ACSs). These syndromes comprise a spectrumof increasingly severe ischemic conditions thatinclude unstable angina, as well as persistentand non-ST-segment elevation acute myo-cardial infarction (AMI), and are currently theleading cause of admissions to coronary careunits worldwide. Herein, the authors present abrief evidence-based overview of the currentand potential role of clopidogrelin ACS.Understanding of the patho-physiology of ACSs has grown tre-mendously over the last decade.ACSs result from the disruption ofatherosclerotic plaque, leading tothe formation of an intracoronarythrombus with aggregated platelets within afibrin mesh. Platelet activation and aggregationare pivotal in the pathophysiology of ACS. Forthese reasons, pharmacologic inhibition of plate-lets has been an attractive strategy for the treat-ment and secondary prevention of ACS. Aspirininactivates the platelet enzyme cyclooxygenase-1by irreversible acetylation, thus leading to directdisruption of thromboxane A2 synthesis andplatelet inhibition. Aspirin has been, andremains, the traditional antiplatelet recom-mended for the treatment of patients with coro-nary heart disease (CHD), based on evidencefrom a large number of clinical trials