From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
The decision to hold Plavix (clopidogrel) after head trauma should be based on the severity of the injury and bleeding risk, with a general recommendation to hold for 3-7 days, as supported by the most recent study 1.
Considerations for Holding Plavix
- For minor head trauma without evidence of bleeding, Plavix may be resumed after 24-48 hours.
- For moderate injuries, a 3-5 day hold is often recommended.
- Severe head trauma with intracranial bleeding may require discontinuation for 7-14 days or longer.
Rationale for Holding Plavix
- Plavix irreversibly inhibits platelet function, which can worsen bleeding in traumatic brain injuries.
- Since platelets live for about 7-10 days, it takes approximately that long for the antiplatelet effect to fully resolve after stopping the medication.
Monitoring and Resuming Plavix
- Patients should be monitored for neurological changes during this period.
- Brain imaging may be necessary before resuming the medication.
- The original indication for Plavix therapy (such as recent stent placement or stroke prevention) should factor heavily into the decision about when to restart, as noted in studies 2, 3.
Key Findings from Recent Studies
- A 2020 study 1 found that antiplatelet therapy is associated with a high rate of intracranial hemorrhage in patients with head injuries.
- Another study from 2018 3 found that patients on antiplatelet drugs have a higher risk of developing intracranial bleeding compared to the general population.
- These findings support the need for careful consideration and monitoring when holding or resuming Plavix in patients with head trauma.