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Australian Journal of Pharmacy : March 2005
ucation receptor inhibitors. They are used with heparin and low-dose aspirin for prevention of ischaemic cardiac complications fol- lowing percutaneous transluminal coronary intervention (abcix- imab, eptifibatide, and in patients with unstable angina or non- Q-wave myocardial infarction (eptifibatide, tirofiban).4–8 Some of the properties of aspirin, clopidogrel, ticlopidine and dipyradamole are shown in Table One. has received in association with clopidogrel (130 of a total of 460 reports). Clopidogrel was the only suspected drug in 27 cases and another 27 cases were attributed to clopidogrel plus aspirin alone. In 63 (48 per cent) of the cases, the patient was taking clopidogrel plus two or more other drugs which are known to cause bleeding (anticoagulants, thrombolytics, platelet inhibitors, NSAIDs). Of the 130 reports, 18 had a fatal outcome.9 In the CAPRIE study (CAPRIE steering committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348:1329–39), the rate of Recent adverse reports to clopidogrel and tipclopidine Haemorrhagic events have been described in 28 per cent of the reports ADRAC9 any bleeding disorder with clopidogrel was 9.3 per cent (15 per cent severe). The risk of bleeding events had been reduced in this study by discontinuing anticoagulants and antiplatelet drugs before randomisation. Further, an early report from the MATCH study of high-risk stroke patients indicates that adding aspirin to clopidogrel doubled the risk of life-threatening bleeds from 1.3 per cent to 2.6 per cent (p<0.001).10 In addition to increasing the risk of haemorrhage, the ADRAC data suggest that concurrent use of more than two drugs with the potential to cause bleeding increases the likelihood of fatality (19 per cent of reports with =three suspected drugs had a fatal out- come.9 Blood dyscrasias, with a total of 80 reports to ADRAC, are another common reaction type with clopidogrel and ticlopidine. Considering usage, ticlopidine is associated with a much higher rate of reporting of agranulocytosis, neutropenia and thrombo- cytopenia than clopidogrel.11 Clopidogrel has largely replaced ticlopidine, because of its greater safety in relation to bone marrow suppression and- thrombotoc thrombocytopaenic purpra (TTP). Allergic cuta- THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 MARCH 2005 ? 207