The funny thing in medicine is , simpler the question , greater the difficulty to answer ! Clopidogrel is an irreversible blocker of platelet aggregation . It probably , is one the top cardiovascular drugs used currently .It came into human domain as an aspirin killer and failed miserably , and currently piggy packing on the ageless aspirin for it ‘s action. The concept of dual antiplatelet agent is a classical example . The fact that , Clopidogrel can rarely be used as a successful mono anti platelet agent while aspirin can do this job with flying colors will unmask the secrets of antiplatelet drug industry .
Do you know , this drug which is considered as a great antiplatelet drug , does not even, pass the basic test of prolonging the bleeding time in a consistent fashion ?
Still , we are not clear why it does or does not increase the bleeding time in vitro or vivo in linear fashion.We have confirmed this in simple bedside experiments. (More dogmatic conclusions can be drawn in bed side , than those double-blind studies) . In many patients 300 mg of clopidogrel failed to prolong the bleeding time even by few seconds ! Surgeons who operate on clopdogelised patients differ widely in their experience when they do emergency surgeries on them .
The issue is very vital , Questions raised are critical !
If clopidgorel has a notoriously unpredictable impact on prolonging bleeding time , Then , is it not dangerous ? , for those millions of patients with DES(Drug eluting stents ) who live at at the mercy of clopidogrel’s erratic behavior.
Cardiology community never got shocked , even as in this era of evidence based cardiology , a drug which is being used for over 10 years without even a basic monitoring strategy for it’s efficacy.
Such is the scenario , it is not at all a surprise , to find a huge population of DES patients who dial 911 or 108 with sub-acute sent thrombosis due to clopidogrel failure and resistance.
Read this article published in one of the prestigious cardio thoracic journal and comprehend yourself about clopidogrel’s controversy .
End of life , is looming large on Clopidogrel , but it has done it’ s intended mission : Increasing the basic cost of cardiovascular care in general population .
A costly and a dubious equivalent to Aspirin wrote a phenomenal success story in the narrow lanes of medical wall street !
No doubt , it will face the same fate as Ticlopidine , Prasugrel has just landed to repeat the same old story !
The easiest job to do in this wold is to fooling around the public
and it is an irony medical professionals and their patients are often