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Stroke and transient ischaemic attack - Management
What precautions should I consider when prescribing clopidogrel?

  • Clopidogrel should be used with caution in:
    • People who may be at risk of increased bleeding from trauma, surgery, or other pathological conditions and in people receiving treatment with aspirin, nonsteroidal anti-inflammatory drugs (including cyclo-oxygenase-2 inhibitors), heparin, or glycoprotein IIb/IIIa inhibitors:
      • Monitor for any signs of bleeding, including occult bleeding, especially during the first weeks of treatment and after invasive cardiac procedures or surgery.
      • The concomitant administration of clopidogrel with warfarin is not recommended because it may increase the intensity of bleeding.
    • People with renal impairment.
    • People with moderate hepatic disease who may have bleeding diatheses.
  • If the person is awaiting elective surgery which does not require an antiplatelet effect:
    • Withhold clopidogrel therapy for 7 days before surgery.
  • Advise people prescribed clopidogrel:
    • To be aware that clopidogrel can increase bleeding time.
    • To report any unusual bleeding (site or duration).
    • To inform their dentist or any other relevant healthcare professionals before any surgery is scheduled.
Basis for recommendation
  • These recommendations are based on those issued by the manufacturer of clopidogrel [ABPI Medicines Compendium, 2007a].
  • Because clinical data are limited, the manufacturer advises caution when using clopidogrel in people with renal impairment or moderate hepatic disease who may have bleeding diatheses.

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