From the Guidelines
After a stroke, you are typically not on Plavix (clopidogrel) and aspirin for life, as the standard recommendation is dual antiplatelet therapy for a limited period, usually 21 days, followed by long-term single antiplatelet therapy with either aspirin or clopidogrel 1. The decision to use dual antiplatelet therapy (DAPT) with Plavix and aspirin is based on the type of stroke and the patient's risk factors.
- For patients with minor ischemic stroke or high-risk TIA, DAPT with aspirin and clopidogrel is recommended for 21 days, followed by long-term single antiplatelet therapy 1.
- The choice of single antiplatelet agent depends on the clinical circumstances, with options including aspirin 81-325 mg daily, clopidogrel 75 mg daily, or aspirin plus dipyridamole 25/200 mg daily 1.
- Regular follow-up appointments are crucial to monitor the patient's response to treatment and adjust medications as needed.
- It's essential to note that longer-term use of DAPT is not recommended for secondary stroke prevention, unless there is an alternate indication, such as a coronary drug-eluting stent requiring dual antiplatelet therapy, due to an increased risk of bleeding and mortality 1.
From the Research
Antiplatelet Therapy After a Stroke
- The use of antiplatelet agents, such as aspirin, clopidogrel, and dipyridamole, is a common practice in the management of patients with ischemic nonembolic stroke and transient ischemic attacks 2.
- Long-term therapy with aspirin, clopidogrel, or aspirin plus extended-release dipyridamole is recommended for secondary stroke prevention in patients with noncardioembolic ischemic stroke 3.
- Dual antiplatelet therapy, such as aspirin and clopidogrel, may be used in the early treatment of atherosclerotic large vessel disease, but long-term use should be individualized due to the higher risk of bleeding complications 2.
Duration of Antiplatelet Therapy
- The duration of antiplatelet therapy after a stroke is not strictly defined, but it is generally recommended to continue treatment for an extended period to reduce the risk of recurrent stroke and death 4.
- Short-term dual antiplatelet therapy with aspirin and clopidogrel may be superior to antiplatelet monotherapy in secondary stroke prevention, but it is associated with an increased risk of major bleeding 3.
- The specific antiplatelet regimen and duration of treatment should be individualized based on the stroke characteristics, time from symptom onset, and patient-specific predisposition to develop hemorrhagic complications 3.
Combination Therapy with Plavix and Aspirin
- There is limited evidence on the use of combination therapy with Plavix (clopidogrel) and aspirin for life after a stroke.
- One study found that treatment with combined aspirin and extended-release dipyridamole versus clopidogrel did not differ in terms of effects on functional outcome, recurrence, death, bleeding, or serious adverse events in patients with acute, mild ischemic stroke 5.
- Another study found that triple antiplatelet therapy with aspirin, clopidogrel, and dipyridamole was associated with a significant increase in adverse events and bleeding rates, and their severity, and a trend to increased discontinuations 6.