From the FDA Drug Label
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 role of Plavix (clopidogrel) post embolic stroke is to reduce the rate of myocardial infarction and stroke in patients with a history of recent stroke 1.
- Key benefits: Clopidogrel tablets are used alone or with aspirin to lower the chance of having another serious problem with the heart or blood vessels, such as heart attack, stroke, or blood clot that can lead to death.
- Important consideration: Patients should not stop taking clopidogrel tablets without talking to the doctor who prescribes them, as stopping clopidogrel tablets too soon may increase the risk of having a heart attack or dying 1.
From the Research
Role of Plavix (Clopidogrel) Post Embolic Stroke
The role of Plavix (clopidogrel) post embolic stroke is to prevent further vascular events, particularly in patients at high cardiovascular risk.
- Clopidogrel blocks platelet aggregation by inhibiting the adenosine diphosphate receptor and the subsequent activation of the complex IIb/IIIa, reducing the risk of stroke and other vascular events 2.
- Antiplatelet medications, including clopidogrel, prevent emboli and thrombus formation to avert further vascular occlusion and ischemia, and are the mainstay of secondary prevention of ischemic and transient ischemic stroke 3.
- The efficacy of clopidogrel in reducing embolization has been evaluated in several studies, including a randomized trial that compared clopidogrel with dipyridamole in addition to aspirin, and found that both treatments reduced embolization to a similar extent 4.
Secondary Prevention of Stroke
Clopidogrel is recommended for secondary stroke prevention in patients with noncardioembolic ischemic stroke, and can be used as monotherapy or in combination with other antiplatelet agents.
- Long-term therapy with aspirin, clopidogrel, or aspirin plus extended-release dipyridamole is recommended for secondary stroke prevention in patients with noncardioembolic ischemic stroke 5.
- Short-term dual antiplatelet therapy with aspirin and clopidogrel is superior to antiplatelet monotherapy in secondary stroke prevention when used in patients with mild noncardioembolic stroke or high-risk transient ischemic attack 5.
- A systematic review and meta-analysis found that short-term aspirin in combination with clopidogrel is more effective as secondary prevention of stroke or transient ischemic attack without increasing the risk of hemorrhagic stroke and major bleeding events 6.
Risks and Benefits
The use of clopidogrel post embolic stroke must be carefully considered, as it can increase the risk of major bleeding events.
- The risk of hemorrhagic stroke and major bleeding events is increased with the use of clopidogrel, particularly when used in combination with other antiplatelet agents 5, 6.
- The benefits of clopidogrel in reducing the risk of stroke recurrence and major vascular events must be weighed against the risks of bleeding complications 5, 6.