Treatment: antiplatelet agent
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Starting treatment
Laboratory tests
- FBC (if signs suggesting bleeding)if neededThe clopidogrel SmPC (RCP) advises prompt blood count in case of signs suggesting bleeding, without setting a frequency [2]. NICE includes haemoglobin in the risk assessment after an acute coronary syndrome [3].
- Serum creatinine (if known or suspected renal impairment)if neededSevere renal failure: aspirin contraindicated; mild to moderate: closer monitoring [4]. NICE includes creatinine in the risk assessment after an acute coronary syndrome [3].
- ASTif neededSevere hepatic impairment: aspirin, clopidogrel, ticagrelor and prasugrel contraindicated [2,4,5,6]; mild to moderate: closer monitoring of aspirin [4].
- ALTif neededSevere hepatic impairment: aspirin, clopidogrel, ticagrelor and prasugrel contraindicated [2,4,5,6]; mild to moderate: closer monitoring of aspirin [4].
- GGTif neededSevere hepatic impairment: aspirin, clopidogrel, ticagrelor and prasugrel contraindicated [2,4,5,6]; mild to moderate: closer monitoring of aspirin [4].
- ALPif neededSevere hepatic impairment: aspirin, clopidogrel, ticagrelor and prasugrel contraindicated [2,4,5,6]; mild to moderate: closer monitoring of aspirin [4].
- Faecal Helicobacter pylori antigen (long-term treatment)if neededBefore long-term treatment (authors' proposal, see the note): the NABM covers screening before long-term low-dose aspirin in asymptomatic patients under 45 [7].
Annual follow-up
Laboratory tests
- FBC (if follow-up of coronary disease, or signs of bleeding)if needednon-French guidelineFollow-up of coronary disease: ESC 2024 provides for yearly blood tests including the full blood count, with no specific link to the antiplatelet [9]. The SmPCs (RCP) and the 2012 ANSM-HAS recommendations set no frequency [2,4,6,12]. Signs of bleeding: FBC without delay [2].
- Serum creatinine (if follow-up of coronary disease)if needednon-French guidelineFollow-up of coronary disease: ESC 2024 provides for yearly blood tests including kidney function [9], and NICE has its monitoring specified in the follow-up plan after myocardial infarction, with no frequency [3]. The SmPCs (RCP) and the 2012 ANSM-HAS recommendations set no frequency [2,4,6,12].
Also consider
Ticagrelor: check at 1 month
Laboratory tests
- Serum creatinine with eGFR
- Serum urateif neededHistory of hyperuricaemia or gout: the ticagrelor SmPC (RCP) advises against use in uric acid nephropathy and recommends caution in case of a history of hyperuricaemia or gout [5].
- About 1 month after starting ticagrelor, in acute coronary syndrome.
Sources (17)
- Assurance maladie. Open Medic 2024, base « nombre de consommants » par code ATC5 (fichier NB_2024_atc5), open-data-assurance-maladie.ameli.fr, téléchargé le 23/10/2026, relu le 24/10/2026.
- Agence européenne des médicaments. Plavix (clopidogrel) : résumé des caractéristiques du produit (EPAR, version anglaise), rubriques 4.3, 4.4, 4.5.
- National Institute for Health and Care Excellence. Acute coronary syndromes. NICE guideline NG185, publiée le 18 novembre 2020.
- Base de données publique des médicaments (ANSM). KARDEGIC 75 mg (acétylsalicylate de DL-lysine) : résumé des caractéristiques du produit, rubriques 4.3 et 4.4.
- Agence européenne des médicaments. Brilique (ticagrélor) : résumé des caractéristiques du produit (EPAR, version anglaise), rubriques 4.3 et 4.4.
- Agence européenne des médicaments. Efient (prasugrel) : résumé des caractéristiques du produit (EPAR, version anglaise), rubriques 4.2 à 4.4.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 du 2 juin 2026 : acte 5236 (antigène fécal H. pylori).
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- Zorginstituut Nederland. Farmacotherapeutisch Kompas (Pays-Bas) : clopidogrel, ticagrélor.
- Cluster Antitrombotisch beleid. Richtlijn Antitrombotisch beleid (Pays-Bas), modules sur les inhibiteurs de COX-1 et de P2Y12, 2026. Richtlijnendatabase.
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- National Institute for Health and Care Excellence. CYP2C19 genotype testing to guide clopidogrel use after ischaemic stroke or transient ischaemic attack. HealthTech guidance HTG724 (ex-DG59), publiée le 31 juillet 2024.
- National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. NICE guideline CG184, publiée le 3 septembre 2014, mise à jour le 18 octobre 2019.
- Talbert M, Close E, Cooke A, Garrett W, Nashelsky J. H. pylori Screening Before Initiation of Long-term NSAIDs. Am Fam Physician. 2019;99(12):783-784.
- Hawkey C, Avery A, Coupland CAC, et al. Helicobacter pylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin in primary care (HEAT): a randomised, double-blind, placebo-controlled trial. Lancet. 2022;400(10363):1597-1606.
- Bundesärztekammer, Kassenärztliche Bundesvereinigung, AWMF. Nationale VersorgungsLeitlinie Chronische KHK, version 7.0, 2024 (Allemagne).