How Long Will I Need to Take Plavix (Clopidogrel) After a Heart Attack?

Coronary artery disease (CAD) is the most common type of heart disease. It's typically caused by a buildup of fat in the arteries (a type of blood vessel) of the heart. Unfortunately, CAD can cause serious health problems. In fact, heart disease is the leading cause of death in the U.S.

Many people with CAD don’t experience symptoms. But, over time, the cholesterol buildup can cause a plaque to form. If the plaque ruptures, a blood clot may form. And, if the clot blocks blood flow to the heart, a potentially deadly heart attack can occur. 

If you’ve recently had a heart attack, you’ll probably need to take medication to help prevent another one from happening. Aspirin and Plavix (clopidogrel) are two common medications that your healthcare provider may prescribe. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) and Plavix is a P2Y12 receptor blocker (inhibitor). 

Even though many people who have a heart attack will take aspirin for the rest of their lives, the same usually isn’t true for Plavix. How long you take the medication depends primarily on your medical history.

When is it recommended to take Plavix and aspirin to prevent heart problems?

Low-dose aspirin and Plavix are known to prevent blood clots from developing in certain people. Low-dose aspirin refers to doses between 75 mg to 100 mg. Most often, the recommended dose is 81 mg, which is commonly referred to as “baby aspirin.” 

If you’ve had a heart attack, your provider may recommend that you take low-dose aspirin and Plavix. These medications can prevent this serious medical event from happening again. Taking the two medications together is called dual antiplatelet therapy (DAPT).

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These antiplatelet medications, as they’re called, prevent platelets from clumping together. The typical function of platelets (a type of blood cell) is to form clots and stop bleeding. But, in some situations, this can cause major health problems like heart attacks and strokes. By preventing blood from clotting, aspirin and Plavix help keep these heart-related issues from occurring again.

Taking aspirin is almost always recommended after a heart attack or stroke. And, compared to aspirin alone, DAPT can lower your chances of getting a blood clot and having a potentially fatal heart-related emergency.. 

DAPT is recommended for people who:

• Have had a heart attack

• Have unstable angina (new or worsening chest pain)

• Have had a stent placed (a tube that helps keep the blood vessels in your heart open)

• Have had coronary artery bypass graft (CABG) surgery (a procedure to improve blood flow to the heart)

Short-term DAPT is sometimes recommended for people who’ve had a stroke or transient ischemic attack (TIA). But this is only for people who meet certain criteria.

How long do I need to take Plavix and aspirin?

How long Plavix and aspirin are taken varies according to the reason they’re being taken in the first place — and a person’s risk of bleeding. Some general guidelines are:

• After a heart attack: at least 12 months 

• With unstable angina: at least 12 months 

• Following stent placement after a heart attack: at least 12 months

• Following stent placement in people with stable heart disease: at least 6 months for a drug-eluting stent and at least 1 month for a bare metal stent

• Following CABG surgery: 12 months

For people who have a high risk of bleeding, DAPT may be more short term. In these situations, a person usually stops taking Plavix earlier but continues taking aspirin. People with a higher risk of bleeding include those who:

• Have a history of prior bleeding, including stomach bleeding

• Take anticoagulants such as warfarin (Coumadin, Jantoven), apixaban (Eliquis), rivaroxaban (Xarelto)

• Are older

• Are of the female sex

• Have a low body weight

• Take certain medications, like corticosteroids or NSAIDs, on a long-term basis

• Have anemia

• Have diabetes

• Have chronic kidney disease

On the other hand, some people with a high risk of blood clots and low bleeding risk may benefit from taking DAPT longer than 12 months. If you’re taking Plavix and aspirin together, talk to your healthcare provider and make sure you know exactly how long to continue treatment.

Plavix dose for antiplatelet therapy

The typical dosage of Plavix, which is only available by prescription, is 75 mg once daily. And the typical recommended dosage of aspirin, which is available over the counter, is 81 mg once daily.

In some cases, a “loading dose” of Plavix or aspirin may be recommended. A loading dose is an initial dose of a medication that’s higher than what the daily dose will be. Loading doses are used to help a medication reach adequate levels in the body quickly.

Is Plavix my only choice for antiplatelet therapy?

There are other P2Y12 inhibitors, like Brilinta (ticagrelor) and Effient (prasugrel), that can be taken as alternatives to Plavix. In fact, Brilinta is only FDA-approved to be taken with aspirin.

Effiient and Brilinta are not the same as Plavix, they are considered to be stronger and faster acting. This means studies have shown they are better at preventing blood clots in heart attack and unstable angina patients. So, in certain situations, these medications may be more effective in a DAPT regimen than Plavix. But they also come with a higher risk of bleeding.

A situation in which Brilinta or Effient may be preferred over Plavix is when someone has had a heart attack and is having a stent placed. In that case, Brilinta or Effient would likely be taken with aspirin as part of DAPT.

But, because of the risk of bleeding, these more potent medications aren’t recommended for certain people. Effient shouldn’t be taken by people who have previously had a stroke or TIA. And Brillinta shouldn’t be taken by those who have had a previous brain bleed, have current internal bleeding, or have severe liver disease. 

Talk to your healthcare provider if you’re not sure which P2Y12 inhibitor might be right for you. They can help you weigh the risks and benefits of these medications. 

When is the best time of day to take Plavix?

There’s no best time of the day to take Plavix, but you should take it at the same time every day (with or without food). In general, try to be consistent with how you take the medication. 

If you miss a dose of Plavix, take it as soon as you remember. But, if it’s almost time for your next dose, skip the missed one and just take a single dose at your usual time. Don’t take two doses of Plavix at once, as it can lead to serious side effects like bleeding.

Side effects of Plavix

Bleeding is the most common side effect of Plavix. This includes serious bleeding, like of the stomach and brain, and less serious kinds, like a nose bleed. Bruising and itching are other possible side effects and, like bleeding, they’re more likely to happen in older adults. 

Contact your healthcare provider if you notice any signs of unusual bleeding, such as:

• Coughing up blood

• External bleeding that won’t stop

• Blood in your stools or black, tarry stools

• Blood in your urine

• Bruises that appear for seemingly no reason and grow in size

Another potentially serious, although rare, side effect of Plavix is thrombotic thrombocytopenic purpura (TTP). This happens when multiple clots develop in smaller blood vessels, which can block blood flow to your organs, damaging them. 

Seek immediate medical attention if you notice the following TPP symptoms:

• Nausea and vomiting

• Confusion

• Fever

• Red spots under the skin (petechiae)

• Purple, red, or yellowish spots on the skin (purpura)

• Seizures

• Yellowing of your skin or eyes (jaundice)

Why trust our experts?

Written by:

Ross Phan, PharmD, BCACP, BCGP, BCPS

Ross Phan is a board-certified clinical pharmacist. She has roughly two decades of healthcare experience — with most of her experience being pharmacy related.

Edited by:

Samvida Patel, MNSP, INHC

Samvida Patel, MNSP, INHC, is a health editor at GoodRx. She is a nutritionist and integrative nutrition health coach with over 8 years of experience in health communications.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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Co-Reviewer: Alice Perlowski, MD, MA, FACC