Many people who are at high risk for a repeat heart attack or stroke take a daily baby aspirin to lower their risk. It has long been viewed as a common way to manage heart disease. However, a meta-analysis of studies found that the blood thinner clopidogrel, often marketed as Plavix, is a significantly better long-term choice for people with coronary artery disease.
Compared to aspirin, clopidogrel lowers the risk of repeat heart attack, stroke or cardiovascular death by about 14 percent without increasing the risk of excessive bleeding. It has only been tested as a secondary treatment, meaning it prevents repeat cardiovascular events. It’s unknown if it can prevent a first-time heart attack or stroke.
As of 2023, clopidogrel is one of the top 50 prescribed medications in the U.S. While the American Heart Association recommends people with peripheral artery disease take clopidogrel over daily aspirin, most other people are still told to take aspirin even though clopidogrel is more effective.
“[T]he body of evidence that has supported the long-term use of aspirin monotherapy for decades is largely based on small studies performed before the advent of modern pharmacotherapies and revascularization strategies,” the researchers wrote. “To the best of our knowledge, clopidogrel monotherapy is the only anti-platelet treatment that has consistently demonstrated greater efficacy than aspirin without compromising safety.”
The advice that people who are at risk for a repeat heart attack or stroke is well-established. It comes from studies from the 1970s and ’80s. Those studies didn’t follow people for very long, and they didn’t look at whether people were using baby aspirin or a higher dose. Today’s guidelines are based on those uncontrolled studies that predate newer, better medications and more controlled research. Health recommendations need to shift when better research and better treatments are available.
While some may worry that it is a prescription and could be expensive, the researchers wrote, “The widespread availability, generic formulation, and affordability of clopidogrel further supports its potential for extensive adoption in clinical practice.” Under a generic name, it’s very affordable. It could be covered by insurance, making it free, unlike the OTC medication aspirin. That could make it an even more appealing treatment option for many people.
While changing guidelines is always a slow and arduous process, you can advocate for yourself. If you take daily aspirin to prevent a repeat cardiac event, you might want to speak to your doctor about switching to clopidogrel. You can advocate for yourself and make the change before the guidelines officially change with your doctor’s help.
