Can aspirin be taken with clopidogrel (Plavix)?

From the Guidelines

Aspirin can be taken with clopidogrel, as this combination has been shown to improve outcomes in patients with acute coronary syndromes, although it increases the risk of bleeding. The CURE trial, a multicenter, randomized, double-blind, placebo-controlled trial, demonstrated that the combination of clopidogrel and aspirin is superior to aspirin alone in reducing cardiovascular events over 3 to 12 months 1. The typical dosage is 75-100 mg of aspirin daily along with 75 mg of clopidogrel daily, though loading doses may be higher initially.

Some key points to consider when taking this combination include:

• The benefits of clopidogrel emerged within 24 hours of initiation of treatment and continued throughout the ensuing 12 months 1.
• The combination of clopidogrel and aspirin increases the risk of major bleeding, although the risk of life-threatening bleeding is not significantly increased 1.
• The selection of an antiplatelet agent should be individualized on the basis of patient risk factor profiles, cost, tolerance, and other clinical characteristics 1.
• Patients taking this combination should be vigilant for signs of bleeding such as unusual bruising, nosebleeds, or blood in urine or stool, and should inform all healthcare providers about taking these medications before any procedures.

It is essential to weigh the benefits and risks of this combination and to monitor patients closely for signs of bleeding. The American Heart Association/American Stroke Association guidelines recommend that the selection of an antiplatelet agent should be individualized on the basis of patient risk factor profiles, cost, tolerance, and other clinical characteristics 1. However, the most recent and highest quality study, the CURE trial, supports the use of clopidogrel in combination with aspirin for patients with acute coronary syndromes 1.

From the FDA Drug Label

Clopidogrel tablets should be administered in conjunction with aspirin. 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.

Aspirin can be taken with clopidogrel. In fact, the drug label explicitly states that clopidogrel tablets should be administered in conjunction with aspirin for certain indications, such as acute coronary syndrome and recent myocardial infarction or stroke 2.

From the Research

Aspirin and Clopidogrel Combination

• The combination of aspirin and clopidogrel is a common dual antiplatelet therapy (DAPT) used to reduce cardiovascular event rates after acute coronary syndrome (ACS) 3.
• Studies have shown that DAPT with aspirin and clopidogrel reduces the risk of cardiovascular events, but also increases the risk of bleeding 4.
• The benefit of adding clopidogrel to aspirin therapy has been demonstrated in patients with coronary disease, ischemic cerebrovascular disease, peripheral arterial disease, or at high risk of atherothrombotic disease 4.

Safety and Efficacy

• The safety and efficacy of aspirin and clopidogrel combination therapy have been compared with other antiplatelet strategies in several studies 5, 6.
• A network meta-analysis found that high-to-low-potency DAPT and aspirin plus prasugrel containing DAPT for 12 months had a significantly lower incidence of major adverse cardiovascular events at 1 year compared with DAPT with aspirin and clopidogrel for 12 months 5.
• However, prasugrel and ticagrelor containing DAPT for 12 months had significantly higher rates of major bleeding 5.

Duration of Therapy

• The optimal duration of DAPT with aspirin and clopidogrel is not well established, but guidelines recommend at least 12 months of therapy for patients with ACS 3.
• Shortening DAPT to 3-6 months reduces bleeding compared with 1 year of treatment, but may be associated with increased ischemic events, mainly in higher-risk patients undergoing complex PCI 6.
• Early aspirin discontinuation at 3 months (and perhaps as early as 1 month) following PCI reduces bleeding, with no evidence to suggest an increase in ischemic events 6.