Clopidra Special Precautions

As with other antiplatelet agents, when considering prescribing clopidogrel, physicians should inquire whether the patient has a history of bleeding. Clopidogrel should be used with caution in patients who may be at risk of increased bleeding from recent trauma, surgery or other pathological condition/s. Because of the increase risk of bleeding, the concomitant administration of warfarin with clopidogrel should be undertaken with caution.
In patients with recent transient ischemic attack (TIA) or stroke who are at high risk of recurrent ischemic events, the combination of aspirin and clopidogrel has not been shown to be more effective then clopidogrel alone, but the combination has been shown to increase major bleeding.
If a patient is to undergo elective surgery, consideration should be given to discontinue clopidogrel 5-7 days prior to surgery to allow for the reversal of the effect.
Clopidogrel prolongs bleeding time. Although it has shown a lower incidence of gastrointestinal bleeding compared to acetylsalicylic acid (ASA) in a large, controlled clinical trial (CAPRIE), clopidogrel should not be used in patients who have lesions with a propensity to bleed. In CURE, the incidence of major gastrointestinal bleeding was 1.3% versus 0.7% (clopidogrel + ASA vs placebo + ASA, respectively). In patients taking clopidogrel, drugs that might induce GI lesions should be used in caution.