Clopidogrel treatment surrounding percutaneous coronary intervention: when should it be started and stopped?

Clopidogrel pretreatment before percutaneous coronary intervention (PCI) has been shown to decrease major adverse cardiovascular events (MACE) at 1 month. This benefit has been demonstrated in patients spanning the entire spectrum of coronary artery disease. Subsequent dual antiplatelet therapy with aspirin and clopidogrel after stent placement is necessary for the prevention of stent thrombosis. The duration of clopidogrel therapy after stent placement is dependent upon the type of stent placed, and is recommended for a minimum of 4 weeks after bare-metal stent placement, 3 months after sirolimus-eluting stent placement, and 6 months after paclitaxel-eluting stent placement. A longer course of therapy with clopidogrel (12 months) has been recommended by the most recent American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions guidelines for PCI based upon incremental reduction in cardiovascular complications (primarily myocardial infarction). This article reviews the data presently available regarding pretreatment with clopidogrel before PCI, and the strength of evidence supporting long-term dual antiplatelet therapy.