March 24, 2023

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After reviewing the aspirin video one of my one of our viewers asked if i would do one on the other anticoagulants so i did i did one on no acts the novel oral anticoagulants talked a little bit about the importance of clot prevention and i can’t believe it i’ve totally forgot to talk about plavix i got into no acts and forgot about it so let’s go back and cover

A little bit about playtex clopidogrel is the name it was approved in 1998 it was the first big generation of new anti-clotting drugs or antiplatelet drugs after coumadin so it created major opportunities for improvement especially in safety at that time is expensive at this point it’s about $25 per month in the us again why do you need platelet inhibitors or clot

Inhibitors well your if you remember it isn’t the plaque that causes the heart attack it’s the clot because is the heart attack yes inflamed plaque can cause a clot i’ve covered that in several other videos just just check them out if you have any questions about it at this point plavix or clopidogrel is on the whi lists of essential medications that means they’ve

Found that it’s needed it’s necessary it’s effective and it’s safe i have a family member who had a significant hemorrhage bleeding problem associated with plavix eclipta degrelle she may or may not agree with the statement that it’s safe but again it is safe compared commit and compared to the options that we had before and if you’re looking at my other video

On the no axe you’ll realize there are even safer options available now there’s been some debate about whether it’s more beneficial to smokers than non-smokers i’m not going to get into that debate either here’s the thing to know about clopidogrel or playtex it has to do with genetics and it actually opened the door for pharmacogenetic testing in fact even today

The major type of pharmacogenetic testing that’s done is with latex and why well play vyx is critical for prevention of heart attack stroke post stent a bunch of different places where just aspirin alone is clearly not enough but what we found was that some people didn’t get that much of an impact from their regular flex dose so here we’ll go into the genetics and

Biochemistry what they found was that flicker clopidogrel is actually the precursor molecule the precursor molecule is broken down by the cytochrome p450 enzymes and don’t don’t drop the video just because you hear big words will go beyond that what happened was some people don’t have very active functions in that area it’s a cytochrome it’s an enzyme made by the

Liver and some people don’t metabolize clip integral if they don’t metabolize it well then the active metabolite doesn’t go out and and decrease platelets play the function or clotting function what was found actually was that those people still had four times the risk of a heart attack or oh posted vanore posts in then people that had a different version normal

Metabolizers of clopidogrel or plavix so in 2010 the fda put a black box warning on it saying love metabolizers don’t get this effect please be sure and go ahead and do pharmacogenetic testing to determine the does you should give again what was weighing in the balance was critical is a heart attack or stroke so even today many people would debate the statement that

Play vixen or clopidogrel is probably the best balance for both safety and cost you just need to get the pharmacogenetics again the best balance in many many situations it’s been for that reason it’s been a blockbuster even in 2009 it was over 7 billion in revenue now the no acts are catching up very quickly because of some advantages they have and i wouldn’t be

Surprised if they pass clopidogrel because what we’re dealing with is far more expensive than any of the new drug costs heart attack and stroke obviously is incredibly expensive in terms of human human potential human resource as well as just money so there are several things that i’ve not covered in this series on anticoagulants i’ve not covered the distinctions

And debate between anti-clotting blood thinners anti platelets etc i may in some future video i haven’t covered things like diaper animal as trademarked as percent and a cochrane review actually showed it as appropriate for some types of stroke prevention again haven’t covered that well what i have covered and what i want to repeat is the big deal in this whole

Area less than a third of the people that need these medications are actually taking them again every when there’s a problem like that everybody wants to throw blame around patients or want to throw want to blame doc’s doc’s want to blame patients or whatever let’s just fix the problem be aware if you have had a stroke if you’ve got atrial fib if you’ve got some

Of these other major indications for need for blood thinners clot buster’s or o’clock preventers atrial antiplatelet drugs whatever you want to call it please consider that strongly if it’s easy to be afraid of a medication because of the dangers but it’s also easy to forget about the dangers associated with not taking those medications

Transcribed from video
Clopidogrel/Plavix: where does it fit between coumadin and the NOACs? By Ford Brewer MD MPH