Can you take Plavix (clopidogrel) along with aspirin?

Taking Clopidogrel (Plavix) with Aspirin

The combination of clopidogrel (Plavix) and aspirin is not recommended for routine use in patients with cerebrovascular disease unless they have specific indications such as acute coronary syndrome or recent coronary stent placement. 1

Appropriate Indications for Combination Therapy

Dual antiplatelet therapy with clopidogrel and aspirin is indicated in specific clinical scenarios:

• Acute Coronary Syndrome (ACS): Clopidogrel should be administered in conjunction with aspirin for patients with non-ST-segment elevation ACS and ST-elevation myocardial infarction 2
• Recent Coronary Stent Placement: Patients with bare-metal stents should receive at least 1 month of dual therapy; those with drug-eluting stents should receive at least 12 months 1
• Unstable Angina or Non-Q-wave MI: Combination therapy with clopidogrel 75mg and aspirin 75-100mg is recommended 1

Contraindications for Combination Therapy

• Cerebrovascular Disease: The combination is not recommended for secondary prevention of stroke or TIA in patients without acute coronary disease or recent coronary stent 1
• Primary Prevention: Dual therapy did not significantly reduce major cardiovascular events compared to aspirin alone (6.8% vs 7.3%) but increased severe bleeding (1.3% to 1.7%) 3
• Recent Ischemic Stroke: Patients treated with both medications showed insignificant reduction in major cardiovascular events (16.7% to 15.7%) but experienced more life-threatening hemorrhages (1.3% to 2.6%) 1

Bleeding Risk Considerations

• Combination therapy significantly increases bleeding risk compared to either agent alone 4, 3
• For every 1000 patients treated with the combination for 12 months, approximately 9 major bleeds and 33 minor bleeds would occur 4
• Consider proton pump inhibitor (PPI) prophylaxis in patients requiring dual antiplatelet therapy to reduce gastrointestinal bleeding risk 1

Alternative Approaches

• For Stroke/TIA Prevention: Use aspirin plus extended-release dipyridamole as first choice, or clopidogrel alone as an alternative 1
• For Aspirin Intolerance: Clopidogrel alone is recommended for those who cannot tolerate aspirin 1
• For Atrial Fibrillation: Anticoagulation therapy is preferred over antiplatelet therapy for stroke prevention 1

Duration of Therapy

• For ACS without stent placement: Typically 12 months of dual therapy 1
• For bare-metal stents: At least 1 month of dual therapy 1
• For drug-eluting stents: At least 12 months of dual therapy 1
• After the recommended duration, most patients should return to single antiplatelet therapy unless specific indications for continued dual therapy exist 1

Common Pitfalls to Avoid

• Premature Discontinuation: Stopping clopidogrel too early after coronary stent placement can lead to stent thrombosis, myocardial infarction, and death 5
• Unnecessary Prolongation: Continuing dual therapy beyond recommended durations increases bleeding risk without proven cardiovascular benefit 4, 3
• Drug Interactions: Certain PPIs (particularly omeprazole) may reduce clopidogrel's effectiveness 1
• Overlooking Bleeding Risk Factors: History of bleeding, older age, renal insufficiency, and concomitant use of anticoagulants or NSAIDs increase bleeding risk 1

Remember that decisions regarding antiplatelet therapy must balance both cardiovascular and bleeding risks. For most patients without specific indications for dual therapy, single antiplatelet therapy is the safer option with comparable cardiovascular protection 1, 4.