Clopidogrel in the management of cerebrovascular events

Clopidogrel-associated acute arthritis

A 54-year-old Japanese man was urgently admitted to our hospital because of "unmovable" polyarthralgia, high fever and pruritus. He had taken clopidogrel 3 weeks before this admission to prevent ischemic cerebrovascular events. On the laboratory values, acute phase reactants and serum IgE were elevated. Although his symptoms had promptly improved with non-steroidal anti-inflammatory drugs (NSAIDs) and cessation of the drug, the same phenomena were re-induced by re-administration of the drug. According to the above manifestations, he was diagnosed as suffering from clopidogrel-associated acute arthritis.

Pattern of clopidogrel exposures reported to Texas poison centers during 1998–2004

BACKGROUND

Information on the management of potentially adverse exposures to clopidogrel is limited.

METHODS

This study examined the distribution of 582 clopidogrel exposures reported to Texas poison control centers during 1998-2004.

RESULTS

Eighty-four percent of cases with a reported dose having a dose < or = 150 mg. Management of 65% of the exposures occurred on site. Of those exposures with a final medical outcome, 73% were classified as no effect. Of those exposures to clopidogrel alone, the most frequent adverse clinical effects were vomiting (2.4%) and dizziness (2.4%). The most frequent treatments were decontamination by dilution (30%), food (12%), and activated charcoal (7%).

CONCLUSION

In the majority of potentially adverse clopidogrel exposures reported to poison control centers the doses are twice the recommended dosage or less. The outcome of such exposures are generally favorable, with few adverse clinical effects occurring.

Clopidogrel versus aspirin in patients with atherothrombosis: CAPRIE-based calculation of cost-effectiveness for Germany

OBJECTIVES

To model the 2-year cost-effectiveness of secondary prevention with clopidogrel versus aspirin (acetylsalicylic acid) (ASS) in German patients with myocardial infarction (MI), ischaemic stroke (IS) or diagnosed with peripheral arterial disease (PAD), based on CAPRIE trial data and from the perspective of German third party payers (TPP).

METHODS

An existing Markov model was adapted to Germany by using German cost data. The model was extended by using different datasets for cardiovascular event survival times (Framingham vs. Saskatchewan health databases) and in two separate scenarios.

RESULTS

The treatment with clopidogrel leads to a reduction of 13.19 vascular events per 1000 patients, of which 2.21 are vascular deaths. The overall incremental costs for the 2-year management of atherothrombotic patients with clopidogrel instead of ASS are calculated to be about euro1 241 440 per 1000 patients. The number of life-years saved (LYS) has been calculated as the difference in the number of life-years lost due to vascular death or events with ASS versus clopidogrel: it is 86.35 LYS when analysis is based on Framingham data and 66.07 LYS with Saskatchewan-based survival data. The incremental costs per LYS are euro14 380 and euro18 790, respectively. Cost-effectiveness is sensitive to changes in survival data, discounting and daily costs of clopidogrel, but stable against substantial (+/- 25%) changes in all other cost data.

CONCLUSION

The findings for Germany are in line with published results for Belgium (euro13 390 per LYS) and also with results for Italy (euro17 500 per LYS), both based on Saskatchewan data, and with a French analysis based on Framingham data (euro15 907 per LYS). Even if no officially accepted cost-effectiveness threshold exists for Germany at present, incremental cost-effectiveness results of less than euro20 000 per LYS for the treatment with clopidogrel can be assumed to be acceptable for German third party payers.