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Antiplatelet agents in a nutshell
Medication Pros Cons
Aspirin 
(50-325 mg /d)
bulletRelatively safe, inexpensive
bulletFirst line agent
bulletReduce stroke risk by 15% compared w placebo
  
Clopidrogel (Plavix)
75 mg qd
bulletabout as safe as Aspirin
bulletabout as effective as Aspirin in preventling stroke and heart attack
bulletMay be better than aspirin in patient with peripheral vascular disease
bulletCost about $110/month
bulletrate of diarrhea, rash, and pruritus was higher than with aspirin
bulletRare TTP (about 4 per million)
Aspirin plus Clopidrogel
bullet

MATCH Results
bullet

Compared to clopidogrel 75 mg alone, clopidogrel plus acetylsalicylic acid (ASA) 75 mg had no significant effect on recurrent ischemic events. 15.7% of patients taking clopidogrel + ASA had a further ischemic event vs 16.73% of patients taking clopidogrel + placebo (p=.244). Patients taking clopidogrel + ASA also experienced significantly more life-threatening hemorrhage compared to patients taking clopidogrel + placebo (2.6% vs 1.3%, p<0.001).
Aspirin 25 mg plus extended release Dipyridamole 200 mg
(Aggrenox 1 bid)
bulletCombination of Aspirin and dipyridamole is better than Aspirin 50 mg/day in preventing stroke
bulletDipyridamole is a vasodilator, may cause headache
bulletCost about $110/month
bulletlittle effect on fatal stroke and myocardial infarction.
Aggrenox vs ASA + Plavix
bulletProfess trial
bulletEnrollment began in Summer 2003
bulletResult pending

 

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Updated Aug 30, 2004

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