Do you consider smoking status when prescribing clopidogrel?

Clopidogrel was a massive earner for its manufacturer while its patent lasted, but like so many drugs which have cost health systems billions in long-term treatment, it may not actually do that much for most people who take it. A meta-analysis of nine trials in patients with established cardiovascular disease, the effect of clopidogrel was highly dependent on smoking status. Those who smoked showed a 25% reduction in a composite outcome of cardiovascular death, myocardial infarction or stroke, compared with a reduction of 8% in non-smokers. This may also apply to the newer agents ticagrelor and prasugrel, though with less certainty.

Source: Doc2Doc BMJ Cardiology - October 7, 2013 Category: Cardiology Authors: Richard Lehman Source Type: forums