Happy new year everyone.
Friend of mine recently had a minor stroke and has been put on Clopidogrel, described to him as a blood thinner.
Having done a little research I see that it's an antiplatelet drug designed to do much the same as an anticoagulant but via a different route.
My question is - is anyone on this group on an antiplatelet drug or are antiplatelet drugs only prescribed for those who've already had a stroke?
All the best
Tim
Good question Tim, my partner at 70yo had a similar mild stroke and is on clopidigrel, I guess for life. I am sure somebody here knows why she was not put on a DOAC or why we AFers are not given clopidogrel, which has a much longer track record.
Incidentally I had a DVT in my leg 25 years ago and was given first heparin and then clopidogrel, which was later stopped.
Thank you.
I was prescribed clopidogrel after a stroke in Feb 18, that was switched to apixaban after AF diagnosis in May 20.Clopidogrel doesn't work for AF whereas apixaban or similar NOACs do.
If the AF is caused by valve disease then NOACs don't work and warfarin is the go to
Thank you. Interesting that it doesn't work for AF - S different type of clotting I suppose.
Antiplatelets like clopidogrel and aspirin have no place in stroke prevention for those with AF They are a valuable tool for use post stroke or in some cases where artificial valves or simlar devices have been fitted. Anticoagulants work by slowing down the clotting process. Antplatelets help stop parts of blood clumping together. They are great at preventing "stuff" from formng on existing clots or foreign bodies like valves or stents.
Some patients my need both . My BIL was on warfarin and aspirin following a metallic valve installation.
Thank you Bob.
The simple answer is = Anticoagulants to prevent clots forming - that is why they are prescribed as a prophylactic treatment - prevention.
Antiplatelets after an event such as stroke or heart attack to help stop platelets clumping.
As you correctly outlined - they work on different levels of what is called the clotting cascade.
Thank you.
Prescribed Clopidogrel (anti platelet) after TIA, and advised this would be for life. Switched to Apixaban (anticoagulant) on diagnosis of Atrial AFlutter. Switched back to Clopidigrol after 2nd ablation proved successful and then back to Apixaban again when subsequently diagnosed with AFib. Should now be on Apixaban for life irrespective of outcomes of Afib ablations (one down, next one probably not far away).
Thank you and hope you get that 2nd ablation soon.
NICE guidelines in the UK stop clinicians from prescribing antiplatelets (aspirin and clopidogrel) for patients diagnosed with AF. Instead, they are prescribed DOACs. DOACs are considered better at preventing the formation of a clot in the heart that then travels to the brain, and have a better stroke v bleeding risk profile. On the other hand, if you’ve had a suspected TIA or stroke and haven’t (yet) been diagnosed with AF a neurologist will prescribe antiplatelets to prevent clot formation in the small vessels of the brain. I’ve taken Clopidogrel in the past (after a suspected TIA), but as soon as you get diagnosed with AF you can’t choose to be prescribed Clopidogrel (though you can take OTC low dose aspirin if you’re not ready to take anticoagulants).
That's very interesting. If you read further on down you'll see a reply from someone who's on both Clopidogrel and Apixaban.
People like me who have had an AF related stroke are prescribed an anticoagulant, but people whose stroke was not related to AF are put on an antiplatelet such as clopidogrel.
Clopidogrel is metabolised by the CYP2C19 enzyme that has 35 variants (known as allele), that can cause clopidogrel and other drugs such as antidepressants to stop working, or metabolised at varying speed up to ultra-rapid. Around 30% of white people have one or more of these alleles, increasing to 60% of South Asian people. I was a stroke lived-experience patient representative in the Bristol University study for NICE, into the feasibility and economics of testing for CYP2C19 allele. The NHS does not screen for allele even though in some cases, clopidogrel will not work for people with heart attacks and strokes. I know of one trial in 2025 that will use a drug metabolised by CYP2C19, but the trial participants will not be tested for allele as the NHS does not test for it. The Bristol University paper has passed peer review and was published by the NIHR in September 2024 (I am named on the cover) : NIHR Health Technology Assessment, Volume 28, Issue 57, September 2024, ISSN 2046-4924.
Very interesting. Thank you.
My mother had minor stroke at a 70. Was put on aspirin initially but this was changed a few years ago to Clopidogrel. She is now 99 and has had no problems since!
Thank you. That's amazing.
I had a heart attack and had balloon angioplasty. I was prescribed clopidigrel for three weeks and was told to stop Edoxaban during that period. After three weeks I was put back on Edoxaban.
Interesting question and feedback. I had a stent fitted a few years back and also have paroxysmal AF and take both Apixaban and Clopidogrel I believe noted to take forever.
Thank you.
About 40 years ago I had several visits to the Cathlab resulting in multiple stents and starting Clopidogrel treatment. I have been on Clopidogrel ever since. The prescription was due to artery blockage, there was not any indication of stroke.
About 3 years ago I was diagnosed AFib and put on Apixaban as well. After a successful cardioversion and a discussion with my cardiologist at the time I stopped the Apixaban. About a year and a half later AFib returned, Apixaban was restarted and a cardioversion was again successful.
In meeting with my EP he understood my reasons and that stopping Apixaban was a reasonable choice. All through I was and still am Clopidogrel.
Sometimes as we age, we develop multiple diseases that force us to make choices in treatment. I am in a study for Alzheimer’s and may (or may not) be taking a drug that has a small risk of minor brain strokes. The risk may increase with Apixaban. As part of the study I am monitored regularly with ecg’s, blood tests, etc. I have chosen to accept the risk of stopping Apixaban.
Thank you. It's reassuring to hear from someone who's been on Clopidogrel for so long and I assume tolerating it well.
My surgeon wants me off blood thinners for 2 weeks before surgery. Other medications?
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