From the Guidelines
Plavix (clopidogrel) is indicated for long-term antiplatelet therapy in patients with non-cardioembolic ischemic stroke or TIA who do not require anticoagulation, at a dose of 75 mg daily. This recommendation is based on the most recent and highest quality study, a systematic review and synthesis of global stroke guidelines published in 2023 1. The study suggests that antiplatelet agents, including clopidogrel, are recommended for secondary stroke prevention in patients with non-cardioembolic ischemic events who do not require oral anticoagulation.
Key Points
- Plavix (clopidogrel) is recommended for long-term antiplatelet therapy in patients with non-cardioembolic ischemic stroke or TIA who do not require anticoagulation 1.
- The standard dosage of Plavix is 75 mg once daily 1.
- In patients with an acute ischemic stroke or TIA, a single loading dose of 300-600 mg may be administered after an intracranial hemorrhage is ruled out on neuroimaging studies 1.
- Plavix may be prescribed either as monotherapy or in combination with aspirin (dual antiplatelet therapy) for patients who have experienced an ischemic stroke or TIA 1.
Specific Patient Populations
- In patients with a minor ischemic stroke (NIHSS ≤ 3) or high-risk TIA (ABCD2 ≥ 4), dual antiplatelet therapy with aspirin and clopidogrel may be initiated as early as possible, ideally within 12-24 hours of symptoms onset 1.
- In patients with embolic stroke of undetermined source (ESUS), antiplatelet therapy, including clopidogrel, is recommended for secondary stroke prevention 1.
- In patients with extracranial artery dissection, either antiplatelet therapy or oral anticoagulants are recommended for at least 3 months 1.
From the FDA Drug Label
- 2 Recent MI, Recent Stroke, or Established Peripheral Arterial Disease In patients with established peripheral arterial disease or with a history of recent myocardial infarction (MI) or recent stroke clopidogrel tablets are indicated to reduce the rate of MI and stroke.
The indication for Plavix (clopidogrel) after a cerebrovascular accident (CVA) or stroke is to reduce the rate of myocardial infarction (MI) and stroke in patients with a history of recent stroke 2 2.
- Key points:
- Clopidogrel is indicated for patients with a history of recent stroke.
- The goal of treatment is to reduce the rate of MI and stroke.
- Clopidogrel should be administered at a dose of 75 mg once daily orally without a loading dose 2.
From the Research
Indication for Plavix (Clopidogrel) after CVA or Stroke
The indication for Plavix (clopidogrel) after a cerebrovascular accident (CVA) or stroke is for secondary stroke prevention.
- Clopidogrel is used as an antiplatelet therapy to prevent further strokes in patients who have had an ischemic stroke or transient ischemic attack (TIA) 3, 4.
- It can be used as a single antiplatelet drug or in combination with aspirin for dual antiplatelet therapy (DAPT) 5, 6.
- DAPT with clopidogrel and aspirin may provide greater protection against subsequent stroke than monotherapy, especially in the first few weeks after the stroke 5, 6.
Benefits and Risks of Clopidogrel
The benefits of clopidogrel include:
- Reduced risk of recurrent stroke and myocardial infarction 4, 5.
- Reduced risk of vascular death and vascular events 6. The risks of clopidogrel include:
- Increased risk of bleeding, including intracranial bleeding and major bleeding 5, 6.
- Increased risk of hemorrhagic stroke with long-term use of DAPT 6.
Recommendations for Use
- Clopidogrel should be started as soon as possible after an ischemic stroke or TIA, and continued for at least several weeks 3, 5.
- The duration of DAPT with clopidogrel and aspirin should be limited to the first few weeks after the stroke, due to the increased risk of bleeding with long-term use 5, 6.
- Patients should be closely monitored for signs of bleeding and other adverse effects while taking clopidogrel 7.