Can Plavix (clopidogrel) be taken with Aspirin (acetylsalicylic acid)?

From the Guidelines

Plavix (clopidogrel) can be taken with ASA (aspirin) for certain cardiovascular conditions, but the decision to use dual antiplatelet therapy should be individualized based on patient risk factors and clinical characteristics, as it increases the risk of bleeding. The typical dosing is 75 mg of Plavix daily along with low-dose aspirin (usually 81 mg daily) 1. This combination is often prescribed after heart attacks, stent placements, or for patients with acute coronary syndrome to prevent blood clots. However, the most recent and highest quality study, which is the 2012 European guidelines on cardiovascular disease prevention in clinical practice, recommends dual antiplatelet therapy with a P2Y12 inhibitor (ticagrelor or prasugrel) added to aspirin for the acute phase of coronary artery syndromes and for the following 12 months, unless contraindicated due to excessive risk of bleeding 1. The guidelines also recommend clopidogrel for patients who cannot receive ticagrelor or prasugrel, and aspirin alone for patients who are intolerant to clopidogrel or have a high risk of bleeding 1. Another study found that the combination of clopidogrel and aspirin increased the risk of hemorrhage and was not recommended for routine secondary prevention after ischemic stroke or TIA 2. It's essential to weigh the benefits and risks of dual antiplatelet therapy and to monitor patients closely for signs of bleeding, such as unusual bruising, nosebleeds, or blood in urine or stool. The selection of an antiplatelet agent should be individualized on the basis of patient risk factor profiles, cost, tolerance, and other clinical characteristics 2. In patients with non-cardioembolic cerebral ischaemic events, anticoagulation is not superior to aspirin and is not recommended 1. The combination of clopidogrel and aspirin works because each medication prevents platelets from clumping together through different mechanisms - aspirin blocks the COX-1 enzyme while Plavix blocks the P2Y12 receptor on platelets. Patients taking both medications should watch for signs of bleeding and take their medications exactly as prescribed, without stopping either one without consulting their doctor, as sudden discontinuation can increase the risk of serious cardiovascular events. It's also important to note that the use of proton pump inhibitors (PPIs) with clopidogrel may reduce the effectiveness of clopidogrel, and the FDA advises healthcare providers to reevaluate the need for starting or continuing treatment with a PPI in patients taking clopidogrel 3. In summary, the decision to use Plavix with ASA should be made on a case-by-case basis, taking into account the patient's individual risk factors and clinical characteristics, and with careful monitoring for signs of bleeding. Key points to consider include:

• The benefits and risks of dual antiplatelet therapy
• The individualization of antiplatelet therapy based on patient risk factors and clinical characteristics
• The monitoring of patients for signs of bleeding
• The potential interaction between clopidogrel and PPIs
• The importance of taking medications exactly as prescribed and not stopping them without consulting a doctor.

From the FDA Drug Label

Clopidogrel tablets are indicated to reduce the rate of myocardial infarction (MI) and stroke in patients with non–ST-segment elevation ACS (unstable angina [UA]/non–ST-elevation myocardial infarction [NSTEMI]), including patients who are to be managed medically and those who are to be managed with coronary revascularization Clopidogrel tablets should be administered in conjunction with aspirin.

Clopidogrel tablets are indicated to reduce the rate of myocardial infarction and stroke in patients with acute ST-elevation myocardial infarction (STEMI) who are to be managed medically. Clopidogrel tablets should be administered in conjunction with aspirin.

Yes, Plavix (clopidogrel) can be taken with Aspirin (acetylsalicylic acid) as it is indicated to be administered in conjunction with aspirin for certain conditions, such as acute coronary syndrome and acute ST-elevation myocardial infarction 4.

• Key points to consider: + The combination of clopidogrel and aspirin increases the risk of bleeding. + The incidence of major bleeding is higher in patients taking clopidogrel with aspirin compared to those taking aspirin alone 5.

From the Research

Combination Therapy with Plavix and Aspirin

The combination of Plavix (clopidogrel) and Aspirin (acetylsalicylic acid) is a common practice in the management of acute coronary syndromes and other cardiovascular disorders. The evidence suggests that this combination therapy can be effective in reducing the risk of adverse vascular events, but it also increases the risk of bleeding complications.

• The study published in the American Heart Journal in 2014 6 discusses the current status and future directions of antithrombotic therapy in acute coronary syndromes, including the use of clopidogrel and aspirin in combination.
• A review article published in Current Medicinal Chemistry in 2005 7 provides an overview of the use of aspirin and clopidogrel in the management of atherothrombosis, highlighting their complementary mechanisms of action and the benefits of combination therapy.
• The American Journal of Health-System Pharmacy published a review in 2015 8 on the use of dual antiplatelet therapy with aspirin and clopidogrel in the setting of secondary stroke prevention, noting that the evidence does not support the routine use of this combination for long-term secondary prevention.

Efficacy and Safety of Combination Therapy

The efficacy and safety of combination therapy with clopidogrel and aspirin have been evaluated in several studies.

• A study published in Clinical Therapeutics in 2003 9 reviewed the available evidence on the use of clopidogrel in the management of acute coronary syndromes, including its use in combination with aspirin, and found that this combination was effective in reducing the risk of recurrent ischemic events.
• A systematic review and meta-analysis published in Medicine in 2021 10 compared the efficacy and safety of clopidogrel and/or aspirin for ischemic stroke or transient ischemic attack, and found that combination therapy was more effective than monotherapy in reducing the risk of recurrent stroke, but increased the risk of major bleeding events.

Key Findings

The key findings from the available evidence are:

• Combination therapy with clopidogrel and aspirin can be effective in reducing the risk of adverse vascular events, but increases the risk of bleeding complications 6, 7, 9, 10.
• The evidence does not support the routine use of long-term combination therapy for secondary stroke prevention 8.
• Combination therapy may be beneficial for patients with minor stroke or transient ischemic attack when started within 24 hours of the ischemic event and continued for a maximum of 21 days 8.