\cite{Song_2020}Therapy Considerations
As mentioned before clopidogrel is a second-generation thienopyridine, introduced in 1988. Historically, ticlopidine was the first member of this class. However, its not insignificant, risk of neutropenia and thrombotic thrombocytopenic purpura led to its predominant replacement by clopidogrel in routine clinical practice.\cite{Kastrati_2004} Currently third-generation P2Y12 inhibitors, prasugrel and ticagrelor gain relevance. This were developed to address the slow onset and heterogeneous platelet inhibitory properties of clopidogrel. Clinical trials show greater benefits from these two in comparison to clopidogrel. \cite{Wallentin_2007}\cite{Gurbel_2009}\cite{Wiviott_2007}\cite{Wallentin_2009}
Initially guidelines like the 2018 European guidelines on myocardial revascularization recommend the use of prasugrel and ticagrelor over clopidogrel.\cite{2019} Nevertheless Clopidogrel is still use and prescribe. \cite{Collet_2020} \cite{Tscharre_2017} Mainly cause in the past decade concern has arisen regarding increase bleeding risk with third-generation thienopyridines, greater costs and other adverse effects (e.g., dyspnea with ticagrelor use).\cite{De_Luca_2016}\cite{Patti_2020}Also there is an important need for real-world studies, there have been contradictory results in for example CHANGE DAPT study that favored clopidogrel over
Acute Coronary Syndrome (ACS)
Acute Myocardial Infarction (AMI)
Cerebrovascular disease
Clopidogrel is used for the secondary prevention of cerebrovascular events, reducing the occurrence of new cerebrovascular accidents in patients with acute ischemic stroke. However, a substantial number of subsequent strokes still occur despite clopidogrel treatment due to interindividual variability in response to treatment. \cite{Pan_2017}
Stent Anticoagulation
Conclusion