What is clopidogrel?

Hi, I'm Sukh Nidja and I'm an interventional cardiologist working in central London. A common question that we get asked is the use of a drug called clopidogrel or clopidogrel. This is a blood thinning medication that we typically give to patients that have either had a heart attack or have needed a stent in their heart arteries. It's a blood thinning medicine that causes platelets to be less active and therefore the blood to be a little thinner. Patients who need to take clopidogrel need to be aware that they can have more bruising if they knock themselves, walk into a table, walk into something in the garden, and that bleeding can be much more frequent if you nick yourself whilst shaving or some other kind of activity. If that occurs, it's important to be aware that you shouldn't stop the clopidogrel without the advice of your cardiologist. Certain types of stents do need patients to continue the clopidogrel because if they're too early then it's much more likely for these stents to block off. That's a frightening condition called stent thrombosis which is thankfully very rare but if medications are stopped too early it can become a much higher risk. Clopidogrel works by passing through the liver and so it can take several hours for it to work. In some patients who've had an acute heart attack we use one of its other types of relatives. There are a number of other blood thinning medications. A common one that we use is a drug called Ticagrelor or Brelique and another one is called Prazugrel which is all very similar to clopidrol in thinning the blood. Some are a little bit more effective than others. We use these medications in a highly selected way and some patients can get some gastric irritation from them so it's super important to let us know if you get reflux or indigestion whilst taking these medications so we can protect your stomach by giving you medicines that stop ulcers. So we typically use clopidogrel in patients who've had a heart attack or those with stents and it typically works by thinning the blood. Main side effects are bruising and bleeding but the vast majority of patients have no symptoms at all whilst taking it. A rare side effect that can occur whilst taking clopidogrel is a rash and in those patients that have had a rash we may ask a dermatology opinion to see what can be done about it. If patients have a true allergy, then we may well need to change the clopidogrel to another drug and other drugs that are suitable include Prasugrel or Ticagrelor. If you have a problem while taking this drug, do please speak to your doctor about it. Super important because these drugs shouldn't be stopped without supervision. Very occasionally patients need to have a medical procedure, perhaps a knee operation or a hip. Maybe they're going to have a dental operation being performed. It's common for other medical doctors to want to stop clopidogrel because it thins the blood it can make it harder for operations to be performed. You must let the doctor who's going to perform the procedure know that you're taking this medication and they may well want to speak to a cardiologist first so they can ascertain and understand why the drug has been given to you and whether it can be stopped safely. In many cases if you've taken the clopidogrel for over three months after the stents have have been placed, we can safely pause the clopidogrel, allow the procedure to occur, and then restart it after the bleeding risks have gone away. So for example, if you're due for a knee operation, the knee surgeon may well speak to me as a cardiologist. I will then give them advice on when they can stop the clopidogrel and for how long for, and then ask them to ensure that you as a patient go back on the clopidogrel as soon as they've done the operation and are satisfied that you're not going to have any further bleeding problems. Propederol is an important medication for your heart, so please don't stop it unnecessarily.