How Long Do I Have to Take Plavix (Clopidogrel)?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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If you have had stent placement after balloon angioplasty for coronary artery disease you will be placed on medications to ensure you don’t form clots inside those stents. One of them is aspirin, which you will take indefinitely after stent placement. The other one is up for debate, though most of you will take clopidogrel the Plavix generic. Now we have a firm answer for how long you take it.

Why do I have to take two antiplatelet meds after stent placement?

Because it saves lives. The risk of coronary artery stent thrombosis (clot formation) and its consequences of heart attack or death are lowered when you use dual antiplatelet therapy (DAPT) with aspirin and a platelet P2Y12 receptor blocker, compared to the use of aspirin alone. So, it’s two medications you’ll be taking.

Does it matter what kind of stent I have?

Yes, and you should have been given a card you can carry in your wallet with your type. For patients treated with drug-eluting or bare metal stents who are not at high bleeding risk, dual antiplatelet therapy (DAPT) for 12 months is the recommendation. The new recommendation is that after 12 months if there is no evidence of major bleeding or other problems with clopidogrel + aspirin, it is suggested you continue that therapy for an additional 18 months. I know, it seems long.

Antiplatelet therapy: at least 12 months, but 18 more?

The optimal duration of dual antiplatelet therapy is not known; 12 months has been the commonly recommended duration. A recent large trial changed recommendations. Rates of stent thrombosis and death from stroke or heart attack were lower when the two meds were continued for 18 more months. However, the rate of moderate or severe bleeding was increased, so assuming you are not at high risk of bleeding, an additional 18 months of treatment will benefit you.

Is Plavix (clopidogrel) my only choice?

There are two P2Y12 receptor blockers: clopidogrel and Effient (prasugrel). Patients rejoiced in 2012 when the generic version of Plavix, which is clopidogrel, became available. Clopidogrel is cheap and the preferred P2Y12 receptor blocker of the two. Effient is a very expensive brand-name-only option, so if for some reason you have a problem taking clopidogrel you can use Effient.

The preferred regimen after bare metal or drug-eluting stent is: aspirin 75 to 100 mg + clopidogrel 75 mg daily. If you are on Effient the dose is 10 mg once daily + aspirin.

Dr O.

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