Why is clopidogrel preferred over ticlopidine?
Lower incidence of neutropenia and thrombocytopenia
Lower incidence of dyslipidemia
Lower incidence of hyperglycemia
Lower incidence of postural hypotention
Ans. is 'a' i.e., Lower incidence of neutropenia and thrombocytopenia Clopidogrel* This newer congener of ticlopidine has similar mechanism of action, ability to inhibit platelet function and therapeutic efficacy, but appears to be safer and better tolerated (CLASSICS study).* Clopidogrel is safer than ticlopidine as it is less associated with hematological dyscrasias than use of ticlopidine. A lower frequency of neutropenia, thrombocytopenia and other bone marrow toxicity compared to ticlopidine has been recorded.* The clopidogrel as aspirin in patients at risk of ischaemic events (CAPRIE) trial has found clopidogrel recipients to have a slightly lower annual risk of primary ischaemic events than aspirin recipients.* The most important adverse effect is bleeding.* Addition of aspirin to clopidogrel has been found to double the incidence of serious bleeding among high risk stroke patients (MATCH study).* A lower frequency of neutropenia, thrombocytopenia and other bone marrow toxicity compared to ticlopidine has been recorded.* Side effects are diarrhoea, epigastric pain and rashes.* Clopidogrel + aspirin is as effective in stented patients as ticlopidine + aspirin. Clopidogrel is 50% absorbed orally and like ticlopidine, it is a prodrug; action lasts for upto 7 days.
Hematology