Monday, June 29, 2015

Combination of Ticlopidine and Clopidogrel

  • both agents are from the same group- thienopyridine, with a similar structure and mechanism
  • the use of combination is not supported by any guidelines
  • moreover, Ticlopidine is a strong CYP2C19 inhibitor. This leads to decreased serum concentrations of active metabolites of Clopidogrel. (interaction: major/fairly reliable)
Recommendation:
  • The combination of aspirin and clopidogrel might be considered for initiation within 24 hours of a minor ischemic stroke or TIA and for continuation for 90 days (Class IIb; Level of Evidence B)
  • For patients with a history of ischemic stroke or TIA, AF, and CAD, the usefulness of adding antiplatelet therapy to Vitamin K Antagonist therapy is uncertain for purposes of reducing the risk of ischemic cardiovascular and cerebrovascular events (Class IIb; Level of Evidence C). 
  • Unstable angina and coronary artery stenting represent special circumstances in which management may warrant DAPT/VKA therapy.
References:
  1. Lexicomp
  2. AHA/ASA Guideline: Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

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