Aspirin and Blood Thinners for PAD - Clopidogrel

What is clopidogrel?

Clopidogrel (klo-PID-oh-grel) is a prescription blood-thinning medication that stops blood clots from forming by preventing small blood cells (platelets) from sticking to each other. Clopidogrel is slightly more powerful than aspirin, and is a safe and effective alternative for women who cannot take aspirin, or for whom aspirin is not strong enough to prevent clots.

See also:

Clopidogrel & Heart Disease
Clopidogrel & Stroke

Who should take clopidogrel to treat PAD?

For women with PAD, clopidogrel is a safe alternative to aspirin to prevent heart attack, stroke, and dying of heart or blood vessel disease.² If you are allergic to aspirin, or if aspirin is not effective at thinning your blood (a condition called aspirin resistance), you may be switched to clopidogrel.

Clopidogrel is also used to prevent blood clots after stent placement to treat PAD, coronary artery disease and carotid artery disease, and occasionally in women with heart valve disease.

Who should not take clopidogrel?

Women with certain conditions that put them at high risk for bleeding problems, such as stomach ulcers or a recent bleeding stroke, should not take clopidogrel.

How effective is clopidogrel in women with PAD?

Clopidogrel is just as safe and may be more effective than aspirin for preventing heart attack, stroke, and dying of heart or blood vessel disease in women with PAD.² The only study so far to compare aspirin and clopidogrel (which included 6,452 patients with PAD, 28% of them women) found that clopidogrel reduced the risk of heart attack, stroke, and dying of heart or blood vessel disease by 24% more than aspirin, without increasing the risk of bleeding problems.¹¹ However, because it is effective, inexpensive, and widely available over the counter, aspirin remains the most commonly used treatment.³

What are the possible side effects?

The side effects of clopidogrel are similar to those of aspirin, including bleeding in the stomach in about 2% of patients.¹¹ Tell your doctor immediately if you experience unusual bruising or bleeding, such as nosebleeds, blood in the urine, or black or bloody stool.

Other side effects of clopidogrel may include diarrhea and skin rashes. Talk to you doctor if you experience them—changing your dose may be able to minimize these problems.

References

1. Hale TW. Medications & Mother's Milk. 13 ed. Amarillo, TX: Hale Publishing, L.P.; 2008.
2. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. Mar 21 2006;113(11):e463-654.
3. Sobel M, Verhaeghe R. Antithrombotic therapy for peripheral artery occlusive disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. Jun 2008;133(6 Suppl):815S-843S.
4. Dorffler-Melly J, Koopman MM, Prins MH, Buller HR. Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment. Cochrane Database Syst Rev. 2005(1):CD002071.
5. Fowkes FG, Price JF, Stewart MC, et al. Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial. JAMA. Mar 3;303(9):841-848.
6. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. Jan 12 2002;324(7329):71-86.
7. Feringa HH, van Waning VH, Bax JJ, et al. Cardioprotective medication is associated with improved survival in patients with peripheral arterial disease. J Am Coll Cardiol. Mar 21 2006;47(6):1182-1187.
8. Belch J, MacCuish A, Campbell I, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ. 2008;337:a1840.
9. Campbell CL, Smyth S, Montalescot G, Steinhubl SR. Aspirin dose for the prevention of cardiovascular disease: a systematic review. JAMA. May 9 2007;297(18):2018-2024.
10. Roderick PJ, Wilkes HC, Meade TW. The gastrointestinal toxicity of aspirin: an overview of randomised controlled trials. Br J Clin Pharmacol. Mar 1993;35(3):219-226.
11. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. Nov 16 1996;348(9038):1329-1339.
12. Ridker PM, Cook NR, Lee IM, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med. Mar 31 2005;352(13):1293-1304.