why is plavix not recommended for cva treatment

FDA recommends that healthcare professionals should: Be aware that some patients may be poor metabolizers of Plavix. They do not effectively convert Plavix to its active form because of low CYP 2C19 activity.The effectiveness of Plavix as a preventive therapy is reduced in these patients.

Full Answer

Is Plavix any better than aspirin?

In summary, clopidogrel appears to be somewhat more effective than aspirin if one is willing to accept the unitary atherosclerosis paradigm. The gain, however, is modest: about 200 patients should use clopidogrel rather than aspirin for 1 year to prevent just one vascular event.

Can Plavix be taken before or after injections?

The trigger point injections in the back does not cause any major bleeding. it can cause only one or two drops of blood to come out. There is no need to skip any dose of Plavix and you need to inform the doctor about the medicine she is taking so that proper precautions can be taken. I hope this answers your query.

Can Plavix be taken before or after a Spinal Tap?

To avoid or delay LP would be very conservative and is likely not necessary for this procedure. For plavix, stopping for 7 days before the procedure or 5 days before followed by a platelet function test showing adequate function seems like a hard stop.

Can Plavix be taken before or after a carotid endarterectomy?

We may have you start taking a blood thinner after surgery. This could be aspirin or Plavix. You will have medicine for pain. If you need a refill, please call your pharmacy during business hours. The pharmacy will call us for approval. Take all your other medicines, unless your doctor tells you not to.

Should I take Plavix after a stroke?

Long-term treatment using clopidogrel in combination with aspirin is not usually recommended after a stroke because the combination is no more effective for preventing another stroke than either clopidogrel or aspirin alone, while using the two in combination increases the risk of bleeding in the brain.

Does Plavix increase risk of stroke?

Combination therapy with clopidogrel (Plavix) and aspirin did not reduce risk of recurrent stroke, but did significantly increase risk of bleeding and death, researchers found.

Which antiplatelet is contraindicated in stroke?

Prasugrel is contraindicated in patients with a history of stroke or TIA because of the increased risk of significant or fatal bleeding, which was established in the 2007 TRITON-TIMI-38 trial comparing dual antiplatelet therapy of prasugrel/aspirin with clopidogrel/asirin in more than 13,000 patients.

Why are anticoagulants contraindicated in stroke?

In agreement with the national guidelines, there is no recommendation and efficacy for using full-dose anticoagulation for treatment of patients with acute ischemic stroke because of limited efficacy and an increased risk of bleeding complications.

Can Plavix cause hemorrhagic stroke?

Recent research has linked Plavix to catastrophic side effects, such as gastrointestinal bleeding, brain hemorrhage, stroke, and death. When used with aspirin, Plavix doubles the likelihood that a person will experience cerebral bleeding, hemorrhage, or other life-threatening side effect.

Can clopidogrel treat stroke?

Background. Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA).

What is the most effective antiplatelet for stroke?

Aspirin, clopidogrel, and aspirin/extended release dipyridamole drug combination remain the first-line antiplatelet drug options following the occurrence of an index ischemic stroke or transient ischemic attack.

When do you start clopidogrel after a stroke?

Recent minor non-cardioembolic ischemic stroke or high-risk TIA, DAPT with aspirin plus clopidogrel should be initiated early (ideally within 12–24 hours of symptom onset and at least within 7 days of onset) and continued for 21–90 days.

Why are strokes Antiplatelets?

Antiplatelet therapy is used for both the management of acute ischemic stroke and for the prevention of stroke. Antiplatelet therapy reduces the incidence of stroke in patients at high risk for atherosclerosis and in those with known symptomatic cerebrovascular disease.

What medication is contraindicated in a patient with a hemorrhagic CVA?

The use of antiplatelet medication after a primary intracerebral hemorrhage (ICH) is commonly perceived as being contraindicated because of the possibility of increasing the risk of further bleeding.

Can blood thinners cause strokes and bleeding in the brain?

Blood thinners are commonly prescribed for stroke survivors at risk of dangerous blood clots. Unfortunately, the blood thinners used to prevent such blood clots can increase the risk of bleeding in the brain, a cause of hemorrhagic stroke.

When do you start anticoagulation after acute ischemic stroke?

Guidelines from the American Heart Association/American Stroke Association state that it is reasonable to start anticoagulation 4 to 14 days after an acute ischemic stroke in the setting of A-fib.

What medications interact with Plavix?

Speak to your doctor about how drug interactions should be managed. Common medications that may interact with Plavix include: amiodarone. apixaban. bupropion. calcium channel blockers. corticosteroids, such as prednisone and methylprednisone. dabigatran.

How long does it take for Plavix to be discontinued?

Plavix may need to be discontinued up to five days before surgery that carries a major risk of bleeding. May cause a condition called Thrombotic Thrombocytopenic Purpura (TPP) - a blood disorder where blood clots form in the small blood vessels of the body.

How long does Plavix last?

Even though the active form of Plavix doesn't last for very long in the body, its effect on platelets lasts for the lifetime of the platelet (7 to 10 days).

What is Plavix used for?

2. Upsides. Plavix may be used for the treatment of unstable angina and for certain types of heart attack (myocardial infarction) to reduce the risk of stroke or heart attack.

What enzymes are involved in Plavix?

Plavix undergoes activation in the liver, through CYP2C19 hepatic enzymes . Some people have defective CYP2C19 enzymes which means they make less active drug from clopidogrel, and its antiplatelet effect is reduced (these people are termed poor metabolizers).

Why is plasmix given?

Plavix may be given to reduce the risk of a heart attack or stroke in certain cardiovascular conditions or following a heart attack or ischemic stroke. People who are poor metabolizers at CYP2C19 may not respond very well to Plavix. Bleeding is the main side effect of Plavix.

How long does it take for Plavix to work?

Can be administered as a loading dose (a bigger than normal, one-off dose) if an antiplatelet effect is needed within hours. Otherwise, it takes several days for the full antiplatelet effect of Plavix to develop with usual dosages. The dosage of Plavix does not need adjusting in people with liver disease.

Why does Plavix not convert to active form?

They do not effectively convert Plavix to its active form because of low CYP 2C19 activity.The effectiveness of Plavix as a preventive therapy is reduced in these patients. Be aware that tests are available to determine patients' CYP2C19 status.

What is a boxed warning on Plavix?

The Boxed Warning is about patients who do not effectively metabolize the drug (i.e. "poor metabolizers") and therefore may not receive the full benefits of the drug. The Boxed Warning in the drug label will include information to: Warn about reduced effectiveness in patients who are poor metabolizers of Plavix.

What is the enzyme responsible for the formation of Plavix?

The liver enzyme CYP2C19 is primarily responsible for the formation of the active metabolite of Plavix. Pharmacokinetic and antiplatelet tests of the active metabolite of Plavix show that the drug levels and antiplatelet effects differ depending on the genotype of the CYP2C19 enzyme. The following represent the different alleles of CYP2C19 that make up a patient's genotype:

Why is plasmix given?

Plavix is given to reduce the risk of heart attack, unstable angina, stroke, and cardiovascular death in patients with cardiovascular disease.

When did the FDA add Plavix to the label?

In May 2009, FDA added information about poor metabolizers of Plavix to the drug label. However, based on additional data reviewed by the agency (see Data Summary below) the Boxed Warning is now being added to highlight the reduced effectiveness of Plavix in these patients and to recommend that healthcare professionals consider use ...

Can you stop taking plasmix?

Not stop taking Plavix unless told to do so by their healthcare professional. Talk with their healthcare professional if they have any concerns about Plavix. Talk with their healthcare professional to see if testing to determine their metabolizer status is appropriate.

What are the side effects of clopidogrel?

Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). Other common side effects of clopidogrel can include shortness of breath.

How long is clopidogrel plus aspirin?

Trials included in the meta-analyses had a clopidogrel plus aspirin arm (long term was 12 months or longer), a comparator arm of either aspirin alone or short-term clopidogrel plus aspirin (6 months or less), and had a planned follow-up of at least one year.

What is the best antiplatelet medicine for a heart attack?

Health care professionals should consider the benefits and risks of available antiplatelet medicines before starting treatment. Clopidogrel is an antiplatelet medicine used to prevent blood clots in patients who have had a heart attack, stroke, or problems with the circulation in the arms and legs.

What is clopidogrel used for?

Clopidogrel is an antiplatelet blood-thinning medicine that may help prevent future heart attacks, strokes, and other clot-related diseases in patients who have already had a heart attack, stroke, or have certain cardiovascular conditions.

Does Plavix change the risk of death?

FDA Drug Safety Communication: FDA review finds long-term treatment with blood-thinning medicine Plavix (clopidogrel) does not change risk of death. This is an update to the FDA Drug Safety Communication: FDA Reviews Long-Term Antiplatelet Therapy as Preliminary Trial Data Show Benefits but a Higher Risk of Non-Cardiovascular Death issued on ...

Does clopidogrel help with blood clots?

It works by keeping the platelets in the blood from sticking together, thereby preventing blood clots that can occur with certain cardiovascular conditions. Clopidogrel is sold under the brand name Plavix and as generics. Clopidogrel increases the risk of bleeding.

Is Clopidogrel safe for use with aspirin?

That is, the adverse mortality findings in the DAPT trial were not confirmed. Clopidogrel is approved for use in combination with aspirin in patients with acute coronary syndrome, or in patients not on aspirin with a history of recent myocardial infarction, recent stroke, or established peripheral arterial disease.

Can you take Plavix with Nexium?

Nov. 17, 2009 - The FDA today warned patients not to combine Plavix with Nexium, Prilosec, and nine other drugs -- including Prozac and Tagamet. The drugs may make the anti-clotting drug Plavix dangerously less effective, the FDA says. They block an enzyme in the body that turns the drug into its active form.

Can you take prilosec before or after taking nexium?

While some doctors have tried to avoid drug interactions by having patients take Nexium or Prilosec 12 hours before or after taking other drugs, the FDA says this strategy will not avoid interactions between Nexium or Prilosec and Plavix.

Can you stop Plavix without a doctor?

Intelence (generic name: etravirine) Felbatol (generic name: felbamate) Patients taking Plavix should not stop taking any of these drugs -- including Nexium and Prilosec -- until speaking with a doctor. It's dangerous to stop taking any medication without medical advice. Patients taking Plavix should call their doctor as soon as possible ...

Does prilosec help with Plavix?

It's not the first time questions have been raised about the potent stomach -acid-reducing drug Prilosec blunting the benefit of Plavix. But data from more recent studies suggested that Prilosec -- and a similar drug called Nexium -- might actually help patients on Plavix.

Does Plavix cover Tagamet?

Patients taking Plavix should call their doctor as soon as possible to discuss all the other drugs and supplements they are taking, including over-the-counter medications. The FDA warning does not cover other acid-reducing drugs except for Tagamet, which inhibits CYP 2C19. The FDA is actively looking at data on other PPIs, ...

Can you use clopidogrel in stroke patients?

The clinical data supporting the use of clopidogrel, however, may provide no compelling justification for using clopidogrel in preference to aspirin in stroke patients.

Is aspirin more effective than clopidogrel?

8 Thus, the possibility exists that at higher doses aspirin may be more effective than clopidogrel in the prevention of recurrent stroke.

Is aspirin an antiplatelet?

However, at present, aspirin must still be considered the antiplatelet agent of choice for use in the prevention of recurrent ischemic events in stroke patients.

Symptomatic Intracranial Atherosclerosis (Secondary Prevention)

DAPT may benefit patients with symptomatic large vessel high-grade intracranial atherosclerosis.

TIA and Minor Stroke (Secondary Prevention)

Additional support for DAPT after ischemic stroke comes from CHANCE (Clopidogrel With Aspirin in Acute Minor Stroke or Transient Ischemic Attack) in which patients with high-risk TIA and low NIHSS stroke were treated with clopidogrel load in the first 24 hours followed by DAPT for 21 days versus aspirin alone.

Atrial Fibrillation (Primary Prevention)

Strokes are a frequent complication of atrial fibrillation, and aspirin is ineffective compared to anticoagulation in reducing risk. 7 The ACTIVE W (Atrial fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events) compared DAPT to warfarin.

Conclusions

Patients with cerebral ischemia are at high risk for early recurrent stroke, and use of DAPT for secondary prevention is reflected in current guidelines.

Teaching Points

Aggressive medical management including aspirin and clopidogrel for 90 days after stroke from intracranial atherosclerosis reduces stroke recurrence compared to historical controls.

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• Plavix may be given to reduce the risk of a heart attack or stroke in certain cardiovascular conditions or following a heart attack or ischemic stroke. People who are poor metabolizers at CYP2C19 may not respond very well to Plavix. Bleeding is the main side effect of Plavix.

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