CLOPIDOGREL AS BARRICADE OF PLATELET AGGREGATION

Clopidogrel with trade name Plavix constitute the medicine as barricade of platelet aggregation. It barricade accordance with selective bundling between adenosin diphosphate (ADP) with platelet receptor, and activate subsequent ADP mediated from GP IIb/IIIa, with the result that hamper platelet aggregation .

Indications :

Myocardial infarctTo prevent the incident of atherothrombotic on :

  • Patient who suffer Myocardial infarct (from some days until less than 35 days), stroke ischemic (from 7 days until less than 6 months) or established peripheral arteriole disease.

  • Patient with acute coronary syndrome.
  • Increasing acute coronary syndrome with elevation on non ST segment (unstable angina, or myocardial infarct non Q wave) in combination with Acethylsalicylic acid.

  • Acute Myocardial Infarct with elevation on ST segment. In combination with Acethylsalisilat acid on therapy the patient accordance with thrombolytic therapy.

Dosages :

Adult and older ages :

Clopidogrel be given as single dose 75 mg per day with meal or without meal. On patient with acute coronary syndrome :

  • Elevation of non ST segment (unstable angina, or myocardial infarct non Q wave): be started with load dose 300 mg and be continued by 75 mg single dose per day (combination with Acethylsalicylic acid 75 – 325 mg once per day). Because high dose of Acethylsalicylic acid relate with the increasing of bleeding risk, so dose of Acethylsalicylic that be recommended not more than 100 mg. The long therapy according to formal not be established.

  • Increasing acute myocardial infarct on elevation of ST segment: be started with single dose 75 mg with or without load dose in combination with Acethylsalicylic acid with or without thrombolytic. For patient age more than75 years, clopidogrel be started without increasing load dose. Combination therapy be started at early maybe after appear the symptom of disease and be continued until minimal 4 weeks.

Children and younger adult :

  • There is not supporting data for children.

Contra Indications :

  • Patient who hypersensitive toward Clopidogrel and its components.
  • Severe liver damage.
  • Active pathologic bleeding like as peptic ulcer or intra cranial bleeding.
  • Give suck.

Warning and Attentions :

  • Because of bleeding risk and hematologic effect which are not be wished, so blood cell count must be done during medicinal treatment.

  • Like other anti platelet clopidogrel must be given carefully on patient who has increase risk of bleeding as consequence of trauma, surgical therapy or other pathologic condition and on patient who receive Acethylsalicylic acid, Anti inflammation non steroid medicine be included barricade Cox-2, heparin, or barricade glycoprotein IIb/IIIa.

  • Patient must wary toward bleeding sign include of hidden bleeding, specifically at the first week of treatment and or after cardiac invasive procedure or surgery.

  • Patient who experience surgery and doesn’t need anti platelet effect, giving clopidogrel must be stopped 7 days before surgery.

  • Clopidogrel will make length of bleeding time and must be given carefully on patient with lesion which trend to experience bleeding ( particularly on gastrointestinal tract and eye ).doctor checkup

  • Patients must inform to doctor or dentist that they are using clopidogrel surgery be scheduled and before receive other medicines.

  • Thrombotic Thrombocytopenia Purpura ( TTP ) has been reported after using clopidogrel short period be signed with thrombocytopenia, hemolytic anemia microangeophatic related with neurological sign, kidney function disorder and fever. TTP be included the condition may be fatal and must be handed quickly.

  • Clopidogrel doesn’t be recommended for patient who suffer acute ischemic stroke ( less than 7 days ), kidney function disorder and moderate liver disease.

  • Patient with galactose hereditary intolerance, lap lactase deficiency or malabsorption of glucose galactose better doesn’t use this medicine.

Side effects :

  • Bleeding and hematologic disorders.

  • Central and peripheral nerve system disorders, not generally: headache, dizzy, paraesthesia, vertigo.

  • Gastrointestinal system disorder, generally: dyspepsia, abdominal pain and diarrhea, not generally: gastric ulcer, duodenum ulcer, gastritis, vomit, nausea, constipation.

  • Platelet disorder, bleeding and coagulation disorder, not generally: increasing of bleeding time, decreasing of platelet.

  • Skin disorder, not generally: skin eruption and itchiness.

  • Leukocyte disorder, not generally: leukopenia, , decreasing of neutrofil and eosinophil.

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