This article is from "Nankai Sun Pharmacist", which is used for medical science popularization for reference. Clopidogrel is a commonly used antiplatelet drug in clinical practice, it is a prodrug, it has no antiplatelet activity, it must be transformed by metabolic enzymes in the liver to generate metabolites with antiplatelet activity, and play a role in inhibiting platelet aggregation and preventing thrombosis by hindering platelet activation, its antithrombotic effect is rapid and powerful, and is mainly used in clinical practice to prevent atherosclerotic thrombosis, including recent myocardial infarction, Patients with ischemic stroke and those with confirmed peripheral arterial disease can also be used in combination with aspirin to prevent thrombosis reformation in patients with acute coronary syndromes, such as those with stenting after percutaneous coronary intervention (PCI).
Clinically, even if some patients take clopidogrel in strict accordance with the conventional dose, they will still have cardiovascular and cerebrovascular events such as myocardial infarction or stroke, this phenomenon is called clopidogrel resistance, the difference in oral absorption of clopidogrel is a risk factor for clopidogrel resistance, although the clopidogrel drug instructions clearly indicate that it can be taken before or after meals, but some studies have shown that food has a significant impact on the absorption of clopidogrel, taking clopidogrel after a meal can significantly improve bioavailability, increase blood concentration, and prolong the time of action, therefore, taking clopidogrel after a meal can increase the absorption rate of the drug and effectively prevent clopidogrel resistanceIt is recommended to take clopidogrel half an hour after a meal.
From a physiological point of view, a variety of physiological activities of the cardiovascular system have circadian rhythms, some people say that the human body has the highest blood coagulation at night, therefore, taking clopidogrel in the morning has the best antiplatelet effect, and some people say that the high incidence of cardiovascular and cerebrovascular events is 6:00 12:00, platelets are more active in the morning, and clopidogrel needs several hours after taking the drug to reach the peak of blood concentration, therefore, clopidogrel should be taken at night before going to bed, if it is taken in the morning, it can not play the best protective role.
At present, there is no randomized controlled clinical study to confirm that clopidogrel can prevent cardiovascular events when taken in the morning or before bedtime, in fact, clopidogrel taken once a day can significantly inhibit platelet aggregation from the first day, and with the prolongation of the drug time, this inhibitory effect is gradually enhanced, and a stable blood concentration is reached in 3-7 days, at which time the average inhibitory level of platelets can reach 40 -60 when clopidogrel 75mg (1 tablet) is taken daily The inhibitory effect of clopidogrel on platelets is irreversible, and it can inhibit platelet function for up to 7-10 days, therefore, clopidogrel can be taken morning and night, the most important thing is to insist on taking it, do not stop the drug by yourself, it is best to conduct genetic testing before taking the drug to determine the gene morphology, and patients with slow metabolism should increase the dose of clopidogrel or switch to other antiplatelet drugs.