Clopidogrel vs aspirin in patients at risk of ischemic events
Common Questions and Answers about Clopidogrel vs aspirin in patients at risk of ischemic events
plavix
Combining plavix and aspirin increases the risk of bleeding vs. aspirin alone in patients treated for more than a brief period of time. That is the regimen followed for my DES implant.
f you are in this category a prior MI and unstable angina:" In the CAPRIE trial, clopidogrel (plavix) was equivalent to aspirin for patients with a recent (but not acute) MI.
Some cardiologists have concluded that these patients, who are at higher risk of a subsequent vascular event, would benefit from combined therapy. In addition, subgroup analysis from CAPRIE has documented that patients who have undergone coronary artery bypass surgery receive particular benefit from continuing combined antiplatelet therapy with clopidogrel and aspirin.
The most widely studied and prescribed antiplatelet agent for the prevention of stroke and other serious vascular events among high vascular risk patients is aspirin. I take aspirin daily prior to CHF..
Plavix and aspirin for preventing stroke and other serious vascular events in high vascular risk patients. Up to one year after a stent implant, plavix and aspirin are the recommended protocol as statistics have shown a high risk for clot.
It seems plavix helps reduce the risk for clots at implant site, and after a year the risk of clots is less than the risk of excessive bleeding with plavix. After a year discontinued plavix and remain on a baby aspirin. Several months ago after some dental work there was excessive bleeding for hours on a baby aspirin...so I'm not cool with large doses of anti-platelet meds.
Warfarin can cause very serious (possibly fatal) bleeding.
What puzzles me is why a blood clot in arteries can be treated with aspirin/clopidogrel combine and the one in heart muscles will require warfarin? And why a blood clot should form on heart muscles which are dead for last six years?
I agree with you that even high dose of aspirin can cause bleeding. But over time I have got used to 150 mg of aspirin daily and psychologically my comfort level is higher.
Thankyou so much for sharing your thoughts.
Without getting into the pharmocological aspects regarding the mechanism of action of asprin resistance and the mechanixm of activity of plavix (clopidogrel), the American Academy of Cardiology recommends tests.
Dr. Waksman:
"I'll try to do my best because it's a controversy.
You need to consult a neurologist for detailed evaluation and clinical correlation. Control of these systemic risk factors, addition of aspirin or clopidogrel could decrease the risk of any strokes if you have these risk factors. Wish you all the best.
Incidence of Bleeding Events in COMMIT (% patients) Type of bleeding Plavix
(+ aspirin)
(n=22961) Placebo
(+ aspirin)
(n=22891) p-value
*
Major bleeds were cerebral bleeds or non-cerebral bleeds thought to have caused death or that required transfusion.
†
The relative rate of major noncerebral or cerebral bleeding was independent of age. Event rates for Plavix + aspirin by age were: <60 years = 0.3%, ≥60 to <70 years = 0.7%, ≥70 years = 0.8%.
In ALL the procedures I've had, I only took 600mg of Clopidogrel. 8 of the little pink blighters.
That’s because aspirin acts as an anti-inflammatory and an inhibitor of blood clotting. For those at risk, aspirin is one of the drugs in our arsenal (along with statins, ACE inhibitors, and beta blockers) that can help keep a coronary event from occurring in the first place or recurring.
As far as what dosage works best in people for whom aspirin is recommended, I suggest you consult your own doctor.
While extending the duration of clopidogrel use may decrease the risk of very late stent thrombosis events, this strategy may also result in an increased risk for major bleeding complications and involves lifestyle modifications, such as deferral of surgical and dental procedures that may affect a patient's health and overall quality of life.
[Finally, it is known that stent thrombosis can occur in some individuals despite the continued use of dual antiplatelet therapy.
Aspirin or coumadin are for clots, (Antithrombotic and Thrombolytic Therapy), the American College of Chest Physicians (ACCP) recommended coumadin for atrial fibrillation patients at high risk of stroke, aspirin for patients at low risk of stroke, and either drug of patients with an intermediate risk. The ACCP defines a low-risk patient as younger than 65 years with no predisposing risk factors (e.g., previous stroke, TIA, embolism, heart failure, hypertension, diabetes).
Hello; I have got one coronary DES stent implanted since two month ago ("Endeavor RESOLUTE RX"). I am on clopidogrel, aspirin, atorvastatin, carvedilol, enalapril and pantoprazol. Fearing about scars growing inside the stent's mesh, I have read that some people recommend vitamin E for cosmetic appearance of scars; well, my question is: Could vitamin E be of some help for preventing "in-stent restenosis"? Is it worth trying? Thanks!
The selection of the antithrombotic agent is usually based on the absolute risk of stroke and bleeding and the relative risk and benefit for a given patient. Based on the level of risk, most patients are either started on aspirin or Warfarin (Coumadin). Clopidogrel (Plavix) is an anti-platelet agent and acts via a different mechanism than coumadin does (coagulation pathway).
I am diabetic and on metformin and also crestor for cholestrol recently I had the cardiac procedure and the following medicaations were added on
apo-clopidogrel 75mg, bisoprolol 5 mg 1/2 a tablet a day along with aspirin . thry tested my urine and found traces of blood. i have severe backaches. what could be the reason ?. is there anything that i coul do witout taking medication please advice . i am 70 years old.
The anti-coagulant drugs must be carefully monitored to maintain a balance between preventing clots and causing excessive bleeding
The lower parameter of 1.5 may be appropriate in weighing risk of clots vs. excessive bleeding. It may be appropriate for some individuals with special needs regarding risks of excessive bleeding even after considering a marginal difference.
Since treatment of clots is very restrictive in her case, maybe aspirin can be tried. In patients on hemodialysis aspirin is known to decrease the chances of stroke, without increasing the chances of bleeding. However, the dose needs to be adjusted well. Also aspirin can be combined with Coumadin. Aspirin can be combined with clopidogrel also and reduces the risk of stroke. Please discuss these options with her treating doctor.
It is becoming more acceptable now that clopidogrel is a benefit for life. While aspirin works on one side of the clotting process, clopidogrel works from another. You say your heart attack was caused by cholesterol but this isn't strictly true. Cholesterol is one of the later processes which makes the heart attack happen but isn't the initial cause. The initial cause is damage to your artery linings which can be through blood pressure or bad diet.
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