Aspirin and Plavix Don't Mix

Clopidogrel and aspirin combination increases risk of bleeding

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Taking both clopidogrel (Plavix) and aspirin together does not appear to cut the risk of recurrent deep brain strokes. Research suggests it also increases the risk of bleeding events or dying.

Though the American Heart Association endorses both anti-clotting medications, current guidelines do not suggest the pair should be taken in combination.

"Follow the stroke prevention recommendations of your cardiologist."

Dr. Oscar Benavente, lead author of the study and a professor of neurology at Canada’s University of British Columbia, said the preliminary results do not support the use of Plavix and aspirin together to prevent recurrent subcortical strokes, which occur when blood vessels become blocked deep in the middle of the brain.

As a result of the finding, investigators ended the anti-clotting portion of the Secondary Prevention of Small Subcortical Strokes Trial (SPS3), the first large-scale study of patients with subcortical strokes in August. A segment of the study examining high blood pressure treatments remains underway.

The research began in March 2003, and included 3,020 patients at 81 facilities in the U.S., Canada, Spain, Mexico and South America. During the randomized double-blind study stroke patients were randomly selected within 180 days of symptoms to receive aspirin and Plavix or aspirin plus a placebo daily.

Early findings suggested that the bleeding risk almost doubled among patients taking aspirin and Plavix, mostly as major bleeds in locations beside the brain, as compared to the group taking aspirin and a placebo. Researchers discovered the bleeding risk among patients taking aspirin and Plavix was 2.1 percent as compared to 1.1 percent in the group that took aspirin plus a placebo.

Aspirin plus Plavix also came with a higher risk of dying at 2.1 percent as compared to a 1.4 percent risk among patients taking aspirin and a placebo. Both groups had a similar rate of stroke recurrence.

The research, funded by the National Institutes of Health, National Institute of Neurological Diseases and Stroke, was recently presented at the American Stroke Association’s International Stroke Conference 2012 in New Orleans.

Reviewed by: 
Review Date: 
February 8, 2012
Last Updated:
February 9, 2012