An Alternative to Aspirin and Clopidogrel

By Bob Jones Jan 7, 2023

If you have suffered a stroke and have had to undergo treatment, you may be able to find an alternative to aspirin and clopidogrel. Clopidogrel is an effective drug for this condition, but there are certain concerns about its safety. This article will discuss some of these risks and the benefits of using the drug.

MACCE in patients receiving clopidogrel compared to aspirin

In a clinical trial, a statistically significant lower risk of major adverse cardiovascular and cerebrovascular events (MACCE) was seen in patients receiving clopidogrel compared to aspirin. These events include myocardial infarction, unstable angina, vascular death and coronary revascularization.

This randomized, placebo-controlled trial was aimed at comparing the effectiveness of clopidogrel and aspirin in reducing the risks of vascular diseases. Both drugs were administered for six to 12 months. During that period, 174 patients experienced a MACCE. Among these, a stroke occurred in 8.8% of the clopidogrel group and in 10.6% of the aspirin group.

Despite the lower risk of recurrent ischemic stroke, there was a significant difference in the rates of recurrent bleeding events. The clopidogrel group had a rate of recurrent gastrointestinal bleeding of 3.9-5.1% within 90 days, which was lower than the aspirin group. However, all-cause mortality was similar among the two groups.

This study compared the safety and efficacy of aspirin plus prasugrel with aspirin plus clopidogrel in patients undergoing PCI. The CAPRIE steering committee conducted a blinded, randomised trial.

After PCI, patients with acute coronary syndromes were treated with aspirin or clopidogrel for six to twelve months. Among these patients, 355 were excluded for a history of coagulopathy, atrial fibrillation and valvular heart disease.

The trial found that clopidogrel monotherapy was superior to aspirin monotherapy in preventing recurrent ischemic stroke, ischemic heart disease, thrombolysis and major bleeding. In addition, it was associated with a lower risk of recurrent vascular events and a lower risk of recurrent hemorrhagic stroke.

There were no significant differences between the clopidogrel and aspirin groups for any secondary end points, including all-cause mortality, recurrent ischemic heart disease and recurrent bleeding events. Although the results of the study may not be applicable to the general population, they suggest that clopidogrel may be an alternative antithrombotic therapy for post-PCI patients.

DAPT with clopidogrel versus aspirin in patients with recent ischemic stroke

In patients with a recent ischemic stroke, dual antiplatelet therapy (DAPT) with clopidogrel versus aspirin is not superior to aspirin alone for primary and secondary prevention of recurrent ischaemic stroke. However, the risk of major bleeding is greater in the DAPT group than in the aspirin group. This may be due to the increased duration of hospitalization associated with prolonged use of DAPT. DAPT should be initiated as soon as possible in patients with indications for this treatment.

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The purpose of this study was to investigate the effectiveness of dual antiplatelet therapy with aspirin and clopidogrel in patients with a recent ischemic stroke. A total of 1494 patients with mild to moderate ischemic stroke were screened and included in the study.

Patients were divided into three groups according to the timing of the trial treatment. The duration of DAPT ranged from 6 months to more than a year for aspirin plus cilostazol. The clopidogrel-aspirin group received 75 mg of clopidogrel per day after stroke hospitalization.

For the aspirin and clopidogrel groups, the rates of hemorrhagic events were not significantly different, although a small number of patients stopped DAPT due to a mild bleeding event. These events are common after an acute ischemic stroke, as the brain is a vulnerable organ to hemorrhage.

In addition, DAPT early after an index cerebral ischemic event did not increase the risk of major bleeding or ICH, as compared to DAPT after an onset of TIA. However, DAPT with ASA+CLO increased the risk of major bleeding after 3 months of follow-up.

In the CAPTIVA trial, the best DAPT regimen was low-dose rivaroxaban with aspirin. The rate of recurrent ischaemic stroke was reduced by 66 percent in the aspirin and clopidogrel group compared to the aspirin alone group.

Clopidogrel resistance and clopidogrel treatment failure rates may be high in East Asians

There are several studies that have shown an association between clopidogrel resistance and increased risk of thrombotic events. The CYP2C19 polymorphism can alter the metabolism of clopidogrel and decrease its clinical effectiveness. These studies have been conducted in patients with cardiovascular disease, but the effects of these variations have not been fully assessed.

Clopidogrel is used for stable coronary artery disease after a recent myocardial infarction. This thienopyridine P2Y12ADP receptor antagonist is effective at inhibiting platelet aggregation. It is a prodrug that requires bioactivation to an active metabolite.

Clopidogrel is metabolized by the CYP2C19 enzyme. Variation in the activity of the enzyme can affect the clinical effects of the drug. An increase in enzymatic activity may be caused by smoking, rifampin, and induction of the enzyme. If a patient has an active CYP2C19 phenotype, the clopidogrel dosage protocol should be altered to avoid side effects.

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Ticagrelor, a more potent inhibitor of ADP-induced platelet aggregation, is also an alternative antiplatelet therapy. The effectiveness of ticagrelor was not significantly different from that of clopidogrel. However, patients who received ticagrelor had a higher rate of major CV events than those who received clopidogrel. Moreover, the age and prevalence of conventional coronary risk factors were higher in the ticagrelor group than those who received clopidogrel.

The HORIZONS-AMI trial evaluated patients undergoing percutaneous coronary intervention (PCI) for a non-ST-segment elevation myocardial infarction. This study was designed to recruit 800 patients from East Asian countries. Patients were eligible if they had a diagnosis of ACS and symptoms of ischemic heart disease within 24 h of randomization.

To determine whether clopidogrel and ticagrelor are effective in the treatment of ACS, PHILO was conducted in Japan. In this study, a parallel-group design was used to explore consistency of effect among patients from different East Asian countries.

Clopidogrel with cilostazol may be an efficacious and safe alternative to the standard DAT regimen

A recent meta-analysis suggests that clopidogrel with cilostazol may be a safe and effective alternative to the standard dual antiplatelet therapy (DAT) regimen. The authors reviewed studies that enrolled patients with coronary heart disease (CHD), and underwent percutaneous coronary intervention (PCI). They analyzed data on clopidogrel and cilostazol efficacy and safety.

Clopidogrel is used in the treatment of acute coronary syndromes (ACS) to prevent thromboembolic events. Its responsiveness to adenosine diphosphate (aDP) is influenced by several factors, including age, weight, gender, and body mass index. However, adenosine diphosphate-induced platelet reactivity is not consistent in all studies.

Several clinical trials have shown that triple antiplatelet therapy, which includes clopidogrel, aspirin, and prasugrel, may be superior to traditional dual antiplatelet therapy in terms of reducing thromboembolic events. However, these trials also showed that triple antiplatelet therapy was associated with increased bleeding complications.

In the RESPOND study, patients with ST-segment myocardial infarction (STEMI) were given either 75 mg clopidogrel or 10 mg prasugrel daily. After 30 days, the high-on-treatment platelet reactivity of the clopidogrel group decreased by 50%, whereas the prasugrel group decreased by 25%.

During the TRIGGER-PCI trial, a high-risk population with a history of stent thrombosis was randomized to clopidogrel, prasugrel, or aspirin. Rates of resistance to clopidogrel were 40.6%, 3.0%, and 5.1%, respectively. Prasugrel reduced the platelet reactivity of both clopidogrel and aspirin, and therefore was more effective in preventing stent thrombosis.

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The TRILOGY trial, another randomized controlled trial, investigated a double-dose clopidogrel and aspirin regimen. The trial involved 9326 patients with medically managed unstable angina. Although the primary endpoint of the trial was not met, the trial demonstrated that a 225-mg dose of clopidogrel was needed to overcome adenosine diphosphate resistance in patients undergoing PCI.

Clopidogrel is not harmful to babies

Clopidogrel is a medication that is used to help prevent the occurrence of serious problems with the heart. The drug works by stopping platelets from sticking together and forming blood clots. However, taking this medication can also lead to a number of side effects.

If you are pregnant, you should know that this medication may cause birth defects. You should also tell your doctor if you are planning to become pregnant. In most cases, it is not harmful to a baby, but some babies have experienced adverse effects.

Clopidogrel can cause a number of bleeding complications, but the majority of the bleeding is minor. It is important to talk to your doctor about any bleeding that you experience while taking the medicine. Your provider will let you know what to do to stop the bleeding.

One of the most common clopidogrel side effects is an upset stomach. This may happen when you take the drug with food or with other medications. Also, the drug can pass into the breast milk of women. Do not breastfeed while you are taking the drug.

If you have an allergic reaction to clopidogrel, you should not take the drug. Other possible clopidogrel side effects include rash and pruritus.

Some people with a slow metabolism of clopidogrel may not have the drug work well. This can be because of a genetic difference in the cytochrome p-450 2C19 (CYP2C19) enzyme. People with this genetic difference may be prescribed other medicines to help them cope with clopidogrel.

Before you start taking clopidogrel, be sure to tell your doctor or pharmacist if you have any allergies or other conditions. They can help you avoid any interactions that could affect the medication’s effectiveness.

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