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1 . 2025

Clopidogrel in coronary medicine: from pharmacology and pathophysiology to real clinical practice

Abstract

The issues of clinical pharmacology of clopidogrel, pathophysiology of coronary atherothrombosis in terms of prerequisites for inhibition of P2Y 12 platelet receptors, modern approaches to rational antithrombotic therapy for coronary heart disease depending on the individual characteristics of the patient are considered. Modern ideas about the mechanism of action and indications for the use of clopidogrel are presented. The results of the main randomized clinical trials and studies of real clinical practice are reflected, which demonstrate the position of clopidogrel relative to acetylsalicylic acid and other (so-called new) P2Y12 receptor inhibitors in the practice of managing patients with coronary heart disease.

The importance of taking into account cytochrome Р450 gene polymorphism and smoking status in determining the potential effectiveness of clopidogrel is shown. The possibilities of assessing the functional state of platelets as a way to predict successful prevention of atherothrombotic events and the risk of hemorrhagic complications during the use of clopidogrel are revealed. Methods for monitoring the safety and effectiveness of antiplatelet therapy are reviewed. Current trends towards reducing the duration of dual antiplatelet therapy after endovascular myocardial revascularization are emphasized. The rationale for the tactics of combination antiplatelet therapy de-escalation in the option of switching from a more potent P2Y12 receptor inhibitor to clopidogrel, as well as in the option of early (relative to the standard) switch from dual to single-component antiplatelet therapy in patients who have undergone percutaneous coronary intervention is given.

Based on the results of the STOPDAPT‑2 study, the concept that clopidogrel may be a reasonable alternative to acetylsalicylic acid one year after percutaneous coronary intervention is substantiated.

Keywords: antiplatelet therapy; clopidogrel; percutaneous coronary intervention; coronary heart disease; platelet functional status; de-escalation; ischemic and hemorrhagic risk; randomized clinical trial; real-life clinical practice study

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Barsukov A.V., Ligidov M.L., Kuznetsov M.V., Borisova E.V., Saraev G.B. Clopidogrel in coronary medicine: from pharmacology and pathophysiology to real clinical practice. Kardiologiya: novosti, mneniya, obuchenie [Cardiology: News, Opinions, Training]. 2025; 13 (1): 58–72. DOI: https://doi.org/10.33029/2309-1908-2025-13-1-58-72 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Andrey G. Obrezan
MD, Professor, Head of the Hospital Therapy Department of the Saint Petersburg State University, Chief Physician of SOGAZ MEDICINE Clinical Group, St. Petersburg, Russian Federation
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