Journal of geodynamics impact factor

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Although clopidogrel has shown a lower incidence of gastrointestinal bleeding compared to aspirin in a large controlled clinical trial (CAPRIE), the drug prolongs bleeding time and should be used with caution in patients who have lesions with a propensity to bleed (particularly gastrointestinal and intraocular). Drugs that might induce such lesions (such as aspirin and nonsteroidal anti-inflammatory drugs) should be used with caution in patients taking clopidogrel (see Interactions with Other Medicines).

Patients should be told that it may take longer than usual for bleeding to stop when they take clopidogrel (alone or in combination with aspirin), and that they should report journal of geodynamics impact factor unusual bleeding (site or duration) to their physician.

Patients should inform physicians and dentists that they are taking clopidogrel before any surgery is scheduled and before any new drug is taken. In patients with recent transient ischaemic attack or stroke who are at high risk of recurrent ischaemic events, the combination of aspirin and clopidogrel has been shown to increase major bleeding.

Therefore, such journal of geodynamics impact factor should be undertaken with caution outside of clinical situations where the combination has proven to be beneficial. Coronary artery bypass surgery. When coronary artery bypass surgery is to be performed, clopidogrel should be suspended at least 5 days before surgery to reduce the risk of bleeding (see Adverse Effects).

Clopidogrel is a prodrug. Inhibition of platelet aggregation by clopidogrel journal of geodynamics impact factor mainly due to an active metabolite. The metabolism of clopidogrel to its active metabolite can be impaired by genetic variations in CYP2C19 and by concomitant medications that interfere with CYP2C19. Although a higher dose regimen in poor metabolisers increases antiplatelet response (see Pharmacology, Pharmacogenetics), an appropriate dose regimen for this patient population has not been established factir clinical outcome trials.

Consider alternative treatment or treatment strategies in patients identified factkr CYP2C19 poor metabolisers (see Dosage and Administration, Pharmacogenetics). Since clopidogrel is metabolised to its active metabolite partly by CYP2C19, use of drugs that inhibit the activity of this enzyme would be expected to result in reduced drug levels of journal of geodynamics impact factor active metabolite of clopidogrel.

The clinical relevance of this interaction is uncertain. Concomitant use of strong or journxl CYP2C19 inhibitors (e. If a proton pump inhibitor is to be used concomitantly with clopidogrel, consider using one with less CYP2C19 inhibitory activity such as pantoprazole. Medicinal products that inhibit CYP2C19 include omeprazole and esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxcarbazepine and chloramphenicol.

Experience with clopidogrel is limited in patients with severe renal impairment. Experience is limited in patients with moderate hepatic disease who may have bleeding diatheses. Clopidogrel should therefore be used with caution in this population. In the CAPRIE study, it was not mandatory to discontinue study medication in the case of an acute outcome event (acute myocardial infarction, ischaemic stroke or lower extremity продолжение здесь and the patients had a favourable outcome as compared to the aspirin group.

In d a of the lack of data, clopidogrel o be recommended in journal of geodynamics impact factor ischaemic stroke (less than 7 days). TTP is a potentially fatal condition requiring prompt treatment, including plasmapheresis (plasma exchange). Thrombocytopenia, neutropenia, aplastic anaemia geodynaics pancytopenia have also been reported very rarely in patients taking clopidogrel journal of geodynamics impact factor Adverse Effects).

Because of the increased risk of bleeding, diflucan com concomitant administration of warfarin with clopidogrel should be undertaken with caution. Carcinogenicity, mutagenicity and impairment factorr fertility. Clopidogrel was not genotoxic in journal of geodynamics impact factor in vitro tests (Ames test, DNA repair test in rat hepatocytes, gene mutation assay in Chinese hamster fibroblasts and metaphase chromosome analysis of human lymphocytes) and in one in vivo test (micronucleus test by the oral route in mice).

There are no adequate and well controlled studies in pregnant women. As animal reproduction studies are not always predictive of a human response, clopidogrel should not be used in women during pregnancy. Effects on ability to drive and geodyjamics machines. No impairment of driving or journal of geodynamics impact factor performance was observed following clopidogrel administration. Journal of geodynamics impact factor geodynaimcs interaction between clopidogrel and aspirin is possible, leading to increased risk of bleeding.

Therefore, concomitant use should be undertaken with caution. However, clopidogrel and aspirin have been administered together for up to one year. See dactor Precautions, General. A pharmacodynamic interaction between clopidogrel and heparin is possible, leading to increased risk of bleeding. The safety of the concomitant administration of clopidogrel, fibrin or nonfibrin specific thrombolytic agents and heparins was assessed in patients with acute myocardial infarction.

The incidence of clinically significant bleeding was similar to that observed when thrombolytic agents and heparins are coadministered with aspirin. The safety of concomitant administration of clopidogrel with thrombolytic agents has not been formally established and should be undertaken with caution.

Oral anticoagulants (including warfarin). Antiplatelet agents (such as eptifibatide, ticlopidine, tirofiban). The effects of clopidogrel and other drugs which inhibit platelet aggregation may be additive, leading to an increased risk of bleeding.

Nonsteroidal anti-inflammatory drugs (NSAIDs). In a clinical study conducted in healthy volunteers, the concomitant administration of clopidogrel and naproxen Daclatasvir Tablets (Daklinza)- FDA occult gastrointestinal blood loss. However, due to the lack of interaction studies with other NSAIDs, it is presently unclear whether there is an increased risk of gastrointestinal bleeding with all NSAIDs.



09.04.2020 in 16:54 Агап:
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10.04.2020 in 07:33 Трофим:
У меня есть интересное предложение по поводу этой статьи и вашего блога,

12.04.2020 in 21:08 Кира:
выше нос

14.04.2020 in 20:15 Юлия:
Браво, эта отличная фраза придется как раз кстати

15.04.2020 in 07:00 Инна:
Прикольно, я тронут)