No Absolute Contraindication to Combining Plavix and Aspirin 81mg
There is no contraindication to taking Plavix (clopidogrel) and aspirin 81mg together—in fact, this combination is specifically indicated and recommended for multiple cardiovascular conditions, particularly acute coronary syndromes and after coronary stent placement. 1
FDA-Approved Indications for Dual Antiplatelet Therapy
The FDA label for clopidogrel explicitly states that clopidogrel should be administered in conjunction with aspirin for:
- Non-ST-elevation acute coronary syndrome (unstable angina/NSTEMI) 1
- ST-elevation myocardial infarction (STEMI) managed medically 1
Guideline-Recommended Uses
After Stent Placement
For patients receiving coronary stents, dual antiplatelet therapy with aspirin 81mg plus clopidogrel 75mg daily should be given for at least 12 months for both bare-metal stents and drug-eluting stents. 2
Acute Coronary Syndromes
In all patients with acute coronary syndromes (with or without PCI), clopidogrel 75mg daily combined with aspirin should be continued for at least 12 months. 2
Chronic Coronary Disease
- After the initial 12-month period post-ACS or stent placement, aspirin 75-162mg daily is recommended indefinitely 2
- Clopidogrel 75mg daily is recommended as an alternative for patients who are intolerant of or allergic to aspirin 2
Important Safety Considerations
Bleeding Risk
The primary concern with dual antiplatelet therapy is increased bleeding risk, not contraindication. The combination increases the risk of:
When to Use Caution (Not Contraindications)
The following warrant careful monitoring but are not absolute contraindications:
- Active pathological bleeding (peptic ulcer, intracranial hemorrhage) is a contraindication to clopidogrel itself 1
- Concomitant use with warfarin or other anticoagulants increases bleeding risk and requires close monitoring with lower aspirin doses (75-81mg) and INR 2.0-2.5 2
- Patients at high risk of bleeding may warrant earlier discontinuation after the minimum recommended duration 2
Optimal Aspirin Dosing with Clopidogrel
After PCI, it is reasonable to use 81mg per day of aspirin in preference to higher maintenance doses when combined with clopidogrel. 2 Research suggests that daily aspirin doses greater than 100mg when combined with clopidogrel may be associated with reduced efficacy and increased harm. 4
Clinical Bottom Line
The combination of Plavix 75mg and aspirin 81mg is not only safe but specifically recommended for patients with acute coronary syndromes, recent stent placement, or high atherothrombotic risk. 2, 1 The key is appropriate patient selection based on cardiovascular indication and bleeding risk assessment, not avoiding the combination due to contraindication concerns. For patients requiring long-term dual antiplatelet therapy, aspirin 81mg is the preferred dose to optimize the benefit-to-bleeding risk ratio. 5, 4