Stroke is a leading cause of morbidity and premature death globally!
Majority of stroke survivors continue to live with disabilities, and the costs of long term treatment provide too much burden on the patient and his family. Stroke is a disease which affects the arteries leading to the brain. It occurs when a blood vessel which carries oxygen as well as nutrients to the brain ruptures or blocked by the clot. Due to this, the part of the brain cannot get the blood (oxygen and nutrients), so brain cells die.
Stroke is a medical condition which needs immediate medical attention. It needs to be diagnosed and treated quickly to minimize brain damage. The most effective mode to prevent stroke is by maintaining a healthy lifestyle and managing the risk factors.
Lifestyle changes such as intake of a healthy diet, quit smoking, regular exercise, maintaining a healthy weight can help you recover from the stroke. In addition to including these lifestyle changes, it is necessary to take medications for the treatment of stroke.
After a recent ischemic stroke, Clopidogrel is widely used in patients. It is a potent oral anti-platelet agent which is used in the treatment of coronary artery disease, cerebrovascular disease and peripheral vascular disease. Aspirin reduces the risk of recurrent stroke approximately by 20%. These are two different classes of drugs. Clopidogrel is an anticoagulant drug, while Aspirin is a non-steroidal anti-inflammatory drug(NSAID). Aspirin is used to reduce the pain, fever and inflammation. It also prevents blood clotting and used to prevent a heart attack as well as stroke.
Clopidogrel inhibits the aggregation of platelet synergistically with Aspirin. These are anti-platelet medicines. Platelets are small blood cells which stick (clump) together during the blood clotting. These medicines prevent clumping and reduce the chances of forming a blood clot (Thrombosis)
Clopidogrel and Aspirin – Combination therapy
The Clopidogrel and Aspirin in a fixed dose combination are more effective as compared to the Aspirin and Clopidogrel alone in reducing the risk of stroke and various ischemic events. Clopidogrel inhibits the aggregation of platelet synergistically with Aspirin.
In combination with Aspirin, Clopidogrel is used to treat severe chest pain, unstable angina, myocardial infarction and other severe cardiac complications.
More significant benefits may achieve through the combination therapy in the treatment of stroke. Due to the combination, low doses of Clopidogrel and Aspirin are administered, which gives more benefits without increasing the risk of bleeding events.
The combination may be prescribed to reduce the risk of heart attack and stroke if you have suffered severe chest pain (unstable angina) or had a heart attack.
How does it work?
Clopidogrel works by preventing the platelets from sticking together and hence prevents from forming clots. It is an anti-platelet drug which helps keep blood flowing smoothly.
Clopidogrel is a prodrug whose metabolite inhibits the platelet aggregation. It is metabolized by the enzyme CYP450 for the production of an active metabolite which inhibits aggregation of platelets. The active metabolite of Clopidogrel inhibits the binding of adenosine diphosphate (ADP) to its platelet P2Y12 receptor, thereby inhibits platelet aggregation.
- Aspirin is an inhibitor of cyclooxygenase and prevents the synthesis of thromboxane A2 (TXA2)which is a potent vasoconstrictor and platelet aggregator. Hence by inhibiting, TXA2 it prevents the platelet aggregation and reduces 13-19% consequences of cardiac vascular events.
- Clopidogrel inhibits the aggregation of platelet synergistically with Aspirin.
Benefits of Clopidogrel + Aspirin
Clopidogrel + Aspirin is used to prevent strokes and heart attacks in persons with heart disease or peripheral vascular disease (blood circulation disease).
- In combination with Aspirin, Clopidogrel is used to treat severe chest pain, unstable angina and cardiac arrest.
- It helps to keep the blood vessels open and prevents the blood clot.
- It prevents myocardial infarction with peripheral arterial disease.
- These are used to prevent the blood clots, which forms hardened blood vessels (atherothrombosis), which can lead to severe cardiac complications like stroke, heart attack and death.
- The combination may be prescribed to reduce the risk of heart attack and stroke if you have suffered severe chest pain (unstable angina) or had a heart attack.
Dosage and administration
The combination of Clopidogrel and Aspirin is well tolerated with a convenient once in a day dosing schedule. The combination product of Clopidegrel and Aspirin is available in the form of tablets.
The dose of the medication depends upon the different factors like age, the severity of the disease, patient’s health, personal risk factors etc. The dose for Clopidogrel and Aspirin is 75 mg and 100mg, respectively, in a fixed dose combination product.
Side effects of Clopidogrel + Aspirin
Generally, this combination is safe and well tolerated with minor side effects, which include bleeding, fever, headache and itchy skin.
The serious side effects of this combination include bleeding, which lasts for a long time, joint pain, upper respiratory tract infections, intracranial haemorrhage, blood in vomiting as well as urine.
Warnings and Precautions
- This product must be used with caution in patients with the history of the peptic ulcer because due to the gastric ulcer, it may cause gastric bleeding.
- It must not be used during the first two trimesters of pregnancy unless the clinical condition of the patient necessitates treatment with clopidogrel/Aspirin.
- There is a pharmacodynamic interaction between heparin and Clopidogrel/Aspirin, which can lead to the risk of bleeding. Therefore, it should be undertaken with caution.
- Overdose can lead to prolonged bleeding time and bleeding complications. Appropriate therapy must be considered if the bleedings are observed.
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