1. Reduces the Risk of Recurrent Heart Attack and Stroke
Plavix (Clopidogrel) is an anti-platelet agent that is prescribed to patients with a history of vascular disease. Plavix has been extensively studied in many large clinical trials of patients with heart attacks. Patients with a history of heart attack, stroke, or peripheral arterial disease are at risk of death from additional cardiovascular events. Plavix is proven to be better than aspirin at reducing the risk of death, stroke or heart attack in these patients. In combination with aspirin, Plavix is shown reduce the chance of a death, stroke or second heart attack after a first heart attack
2. Decreases the Stickiness of Platelets
Platelets are small discs that circulate in the blood. They are activated in response to injury and circulate to bleeding sites and create a small "patch-like" network of factors to stop bleeding. They are fundamental to the cause of heart attack and stroke. When a plaque inside a coronary artery or cerebral blood vessel ruptures, platelets are rapidly activated and result in the formation of a clot inside the vessel. This clot prevents blood from reaching the tissues and result in damage (heart attack or stoke). A simple aspirin can help to reduce the size of the clot by deactivating platelets. Plavix functions via a different pathway to deactivate platelets. In the setting of a heart attack, the two agents together can be life saving.
3. Plavix is Required After Many Cardiac Procedures
Plavix, after a stent procedure, is necessary to help prevent the chance of clot formation inside the small metal tube. The body will cover the metal with a layer of cells. A bare metal stent requires Plavix and aspirin be taken together for a total of 1 month. Drug-coated stents have a layer of medication covering the metal to reduce the chance of scar formation inside the stent after the procedure. Plavix is required for 12 months after a DES implant. Even on Plavix and aspirin, there is a rare chance that the stent can clot. Other common procedure that require Plavix and aspirin are carotid stenting, peripheral stenting (legs, arms or kidney), ASD closure and PFO closure.
4. Increases the Risk of the Bleeding
Plavix alone can cause bleeding at rates that are similar to aspirin. In combination with aspirin, there risk of bleeding is increased. Most commonly patients will complain of easy bruising or bleeding when shaving. In some cases, severe bleeding, including gastro-intestinal or urinary bleeding, can occur and patients will have to stop Plavix. If a patient needs surgery, Plavix will need to be stopped to prevent bleeding during the procedure.
5. Plavix Resistance May Reduce its Effectiveness
Thirty percent of patients have a genetic defect that reduces the effectiveness of Plavix. After a stent procedure, this may predispose a patient to stent clotting and a possible heart attack. Blood testing can determine if a patent is a responder to Plavix or carries the genetic defect that reduces the response to Plavix, but they are primarily used in a research setting. Research is underway to determine if higher doses of Plavix can overcome this resistance. The proton pump inhibitor omeprazole is also implicated in reducing the effectiveness of Plavix and should be avoided when patients are on Plavix.
