Antiplatelet Drugs

Background

Antiplatelet drugs are used to lower the risk of heart attacks and strokes and to treat people who have artery blockages in their legs. They work by reducing the formation of blood clots, which can lead to heart attacks and strokes.

To help you and your doctor choose an antiplatelet medicine if you need one, Consumer Reports has evaluated the drugs in this category based on their effectiveness, safety, and cost. This brief is a summary of a 17-page report you can access on the Internet at www.CRBestBuyDrugs.org. You can also learn about other drugs we’ve analyzed on this free Web site. Consumer Reports Best Buy Drugs should not be viewed as a substitute for a consultation with a medical or health professional. This report and the information on our website are provided to enhance — not to replace — your communication with your doctor.

Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need an Antiplatelet Drug?

If you have high blood pressure, high cholesterol, or diabetes, or you smoke, are overweight, or have a family history of early heart disease, you may already be taking medicines to lower your risk of heart disease and stroke. Your doctor is likely to advise that you take an antiplatelet drug, too, such as aspirin, unless you have a history of internal bleeding, such as an ulcer. Likewise, if you have been diagnosed with heart disease, have had a heart attack or stroke, or have had blood clots in your legs, you are a candidate for treatment with an antiplatelet.

Evidence Summary

Brand Name(s)

Generic Name

Effective in Preventing Heart Attack or Death in People with Acute Coronary Syndrome?

Effective in Preventing Second Stroke in People Who have had a Stroke?

Effective in Preventing Death in People with Peripheral Vascular Disease?

Increased Risk of Internal Bleeding When Taken with Aspirin?

Bayer, Bufferin, others

Aspirin

Yes

Yes

Yes

N/A

Aggrenox

Aspirin/extended-release dipyridamole

No evidence

Yes

No evidence

Yes

Aspirin plus Plavix

Aspirin plus Clopidogrel

Yes

No evidence

Probably

Yes

Plavix

Clopidogrel

Yes

Probably

Probably

Yes

N/A = not applicable; aspirin by itself increases risk of internal bleeding.

Your Treatment Choices

Condition/Your Health Status

Best Treatment1

Best Treatment if You Can’t Take Aspirin2

Less Effective, Less Safe, or No Evidence For

Comments or Cautions

Have Acute Coronary Syndrome (also called unstable angina) or Had a Heart Attack)3

Aspirin + clopidogrel (Plavix)

Clopidogrel (Plavix)

Prasugrel (Effient),

Ticlopidine, Aggrenox

Aspirin + clopidogrel shouldn’t be taken by people at higher risk of stomach bleeding or ulcers.

Had a Stent Implanted

Aspirin + clopidogrel (Plavix)4

Clopidogrel (Plavix)

Prasugrel (Effient),

Ticlopidine, Aggrenox

Strong evidence for benefit of the combination of drugs. Prasugrel is similar to clopidogrel for reducing all-cause and cardiovascular death with a slightly higher risk of bleeding.

Have Had a Stroke or Transient Ischemic Attack (TIA)

Aggrenox or clopidogrel (Plavix) or aspirin

Clopidogrel (Plavix)5

Prasugrel (Effient),

Ticlopidine

Aspirin alone has been found less effective than Aggrenox, and clopidogrel is similar to Aggrenox.

Have Peripheral Vascular Disease 6

Aspirin

Clopidogrel (Plavix)

Prasugrel (Effient),

Ticlopidine, Aggrenox

Evidence suggests aspirin and clopidogrel are similar.

1. “Best Treatment” indicates best initial treatment for the majority of patients. Individual circumstances vary, however, and your doctor may advise another treatment course for good clinical reasons.

2. Some people are allergic to aspirin, or are particularly sensitive to its adverse effects on their stomachs, with a resultant higher risk of stomach bleeding and ulcers.

3. Acute coronary syndrome indicates a heart attack might be imminent.

4. Except for people who are at higher risk of internal bleeding, for example from stomach ulcers. The combination in some people adds to that risk. It can also add to the risk of bleeding in the brain, which can trigger a kind of stroke called a hemorrhagic stroke.

5. Not strong evidence for clopidogrel in preventing secondary strokes; aspirin second best choice if you can take it.

6. Peripheral vascular disease mostly involves blood clots and vein blockages in the legs. This can occur in one or both legs.

Our Recommendations

The antiplatelet drugs are among the most widely used in the world. They are used to lower the risk of heart attack and stroke under a variety of circumstances. They are highly effective in doing so.

The antiplatelet drugs work by decreasing blood clotting, which evidence now shows is directly linked to heart attack and stroke risk. In people whose arteries have narrowed from atherosclerosis — the “hardening of the arteries” that is the basis of coronary artery disease and peripheral artery disease (in the legs and neck, for example) — blood clumping and clotting can become dangerous.

Taking the evidence for effectiveness, safety, side effects, and cost into account, we have chosen the following as Consumer Reports Best Buy Drugs for people in the following clinical circumstances:

  • Aspirin plus clopidogrel (Plavix) — If you’ve been diagnosed with acute coronary syndrome (e.g. unstable angina) or have had a heart attack or stent implanted.
  • Clopidogrel (Plavix) — If you can’t take aspirin and have been diagnosed with acute coronary syndrome or had a stent implanted.
  • Aspirin — If you have peripheral vascular disease.

Be sure to ask your doctor about generic clopidogrel, which should become available in the spring of 2012.

This report was published in September 2011.

Cost Comparison

Generic Name and Dose

Brand NameA

Frequency of Use per DayB

Average Monthly CostC

Aspirin tablet 81 mg–325 mg

Bayer, Bufferin, others, and generic

One

$1E

Aspirin/dipyridamole sustained-release capsule 25 mg/200 mg

Aggrenox

Two

$247

Clopidogrel tablet 75 mgD

Plavix

One

$214

Prasugrel tablet 10 mg

Effient

One

$222

Prasugrel tablet 5 mg

Effient

One

$231

Ticlopidine tablet 250 mg

Generic

Two

$64

A. “Generic” indicates that this drug is sold as a generic.

B. Frequency of use reflects usual frequency; some products may be used more or less frequently.

C. Prices reflect nationwide retail average for April 2011, rounded to the nearest dollar; prices are derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

D. Generic clopidogrel is expected to become available the spring of 2012.

E. Average aspirin prices were calculated by Consumer Reports Best Buy Drugs using prices obtained from seven online drugstore retailers: Costco.com, CVS.com, Drugstore.com, Familymeds.com, Healthwarehouse.com, Kroger.com, and Target.com.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health-care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, noncommercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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