From the Research
An 81-year-old patient on Plavix (clopidogrel) typically does not need to take aspirin as well, unless specifically prescribed for dual antiplatelet therapy, as the most recent and highest quality study suggests that clopidogrel alone may be sufficient for preventing cardiovascular events in elderly patients with ischemic stroke 1. For most patients, Plavix alone is sufficient as a single antiplatelet agent. Adding aspirin increases bleeding risk, which is particularly concerning in elderly patients who already have higher baseline bleeding risks. The decision should be based on the specific indication for antiplatelet therapy - for example, recent stent placement might warrant temporary dual therapy, while long-term secondary prevention of stroke or peripheral artery disease often requires only single antiplatelet therapy. If the patient has had a recent acute coronary syndrome or coronary stent placement, dual therapy might be recommended for a limited time (typically 1-12 months depending on stent type and bleeding risk). Some key points to consider include:
- The patient's risk of recurrent stroke and major bleeding events, as evaluated in a study comparing clopidogrel and aspirin use among patients aged 80 years or older 1
- The potential benefits of dual antiplatelet therapy, including reduced risk of myocardial infarction and ischemic stroke, as seen in a study comparing clopidogrel plus aspirin with aspirin alone 2
- The increased risk of major and minor bleeding associated with dual antiplatelet therapy, as reported in several studies 2, 3, 4 The patient's physician should evaluate the individual risk-benefit profile, considering factors like fall risk, history of bleeding, and specific cardiovascular condition being treated. Plavix works by inhibiting platelet aggregation through blocking the P2Y12 receptor, while aspirin inhibits the COX-1 enzyme pathway, so combining them provides more complete platelet inhibition but at the cost of increased bleeding risk. However, the most recent study suggests that clopidogrel alone may be a better option for elderly patients with ischemic stroke, due to its lower risk of recurrent stroke and major bleeding events compared to aspirin 1.