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Clopidogrel, sold under the brand name Plavix among others, is an antiplatelet medication used to reduce the risk of heart disease and stroke in those at high risk. [10] It is also used together with aspirin in heart attacks and following the placement of a coronary artery stent (dual antiplatelet therapy). [10]
For many years dual treatment with the cyclooxygenase-1 (COX-1) inhibitor aspirin and clopidogrel was routine practice and served as the main antiplatelet agents for the prevention of thrombotic events as they have the capability to powerfully manipulate platelet biology, which plays a central part in thrombosis.
The antiplatelet medications, aspirin and clopidogrel, are both recommended for secondary prevention of stroke after high-risk TIAs. [22] [21] [23] The clopidogrel can generally be stopped after 10 to 21 days. [23] An exception is TIAs due to blood clots originating from the heart, in which case anticoagulants are generally recommended. [21]
Often a combination of aspirin plus an ADP/P2Y inhibitor [7] (such as clopidogrel, prasugrel, ticagrelor, or another) is used to obtain greater effectiveness than with either agent alone. This is known as "dual antiplatelet therapy" (or DAPT).
Both aspirin and clopidogrel may be useful in the first few weeks after a minor stroke or high-risk TIA. [128] Clopidogrel has less side effects than ticlopidine. [ 127 ] Dipyridamole can be added to aspirin therapy to provide a small additional benefit, even though headache is a common side effect. [ 129 ]
Aside from aspirin, three antiplatelet agents taken by mouth have been approved for use in acute coronary syndromes, clopidogrel, ticagrelor and prasugrel; all reduce platelet aggregation by inhibiting the P2Y 12 receptor, a type of adenosine phosphate receptor, on the surface of platelets. Not all three of them are equally indicated in all ...
aspirin: antiplatelet risks for GI tract bleeding and hemorrhagic stroke [40] [41] [32] [42] [43] dipyridamole: platelet aggregation inhibitor oral or intravenous Abdominal or stomach cramps, diarrhea, dizziness or lightheadedness [44] [45] [46] [41] clopidogrel: antiplatelet [45] [41] ticlid: enoxaparin: anticoagulant
In this three-year study, the addition of vorapaxar to standard of care (aspirin and/or an ADP antagonist such as clopidogrel) significantly reduced the risk of the primary composite endpoint of cardiovascular death, heart attack, stroke, or urgent coronary revascularization by 12 percent compared to placebo plus standard of care. Vorapaxar ...