Acute coronary syndromes ACS is a spectrum of clinical presentations grouped together which includes unstable angina, ST-segment elevation myocardial infarction ie STEMI and non-STEMI NSTEMI. 4,5 The advantages of combining clopidogril with aspirin has shown to be beneficial in patients with ACS.6 Among patients undergoing percutaneous coronary intervention (PCI), it is estimated that 15% or more are at high risk for bleeding.7,8 Clopidogrel is used to prevent heart attacks and strokes in persons with IHD/PVD .It is used along with aspirin to treat unstable angina and to keep blood vessels open and prevent clot formation after certain procedures such as PCI.It works by blocking platelets and prevents them from forming harmful blood clots. This “anti-platelet” effect maintains the patency of the blood vessel and keeps blood flowing smoothly. Side effects like bleeding ,easy bruisbility upper GI bleeding may occur..Serious bleeding in the brain / stomach may occur. Also, clopidogrel can rarely cause TTP which is a potentially dangerous condition .Symptoms may appear any time after starting this medication severe abdominal pain ,profuse bleeding from the nose/gums ,malena,neurological symptoms like confusion fainting attacks with or without severe headaches may occur Allergic reactions rash /itching with breathlessness or dizziness is also noted in these patients After stent placement, patients are usually given 12 months of dual antiplatelet therapy consisting of aspirin plus either clopidogrel (Plavix) or prasugrel (Effient). PTCA is most commonly done for patients with acute coronary syndromes. The increased rate of side effects was evident in patients receiving clopidogrel but not prasugrel The risk and the benefitsof dual antiplatelet therapystill remain unclear 9.In menstrurating women one needs to be careful while prescribing these drugs as they can result in severe menorrhagia After ruling out any pelvic pathology LNG –IUS is the best modality for treatment of heavy menses Also monitoring of PT/INR ratios and APTT levels is mandatory .
