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How Do I Choose an Appropriate Clopidogrel Alternative?

By Lee Johnson
Updated Feb 15, 2024
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Choose an appropriate clopidogrel alternative by looking at other anti-platelet medications and determining which one is the best option for the specific patient. Drugs such as aspirin, dipyridamole, and glycoprotein IIb and IIIa antagonists can serve as possible clopidogrel alternatives. The specific drug best taken by the patient should be decided by a doctor, based on the effect of the drug and the likelihood of any reactions with other medications. Possible side effects of the alternative treatments can also be taken into account when searching for a suitable drug.

Clopidogrel can be classified as an anti-platelet drug, which means that it reduces the effects of platelets within the blood, which are responsible for forming blood clots. The supression of bloode clots is particularly useful for patients who have recently experienced strokes, heart attacks, blood circulation disease, and unstable angina. Clots form in response to even a small tear in a blood vessel. The platelets within the blood clump together and form a clot to plug up the hole in the blood vessel. Clopidogrel works on the ADP receptor, essentially preventing platelets from bonding together to form clots.

Determining which drug is an appropriate clopidogrel alternative can be a complex procedure because other anti-platelet drugs work by slightly different mechanisms. Low doses of aspirin is generally thought to be a good clopidogrel alternative, but clopidogrel is only ordinarily given to patients who have an intolerance to aspirin. Aspirin works to reduce blood clotting by inhibiting the action of the catalyst responsible for the production of thromboxane, which essentially tells nearby platelets to come and help out with the clotting. The drug also has other positive qualities, such as anti-inflammatory, analgesic, and anti-oxidant effects which can be beneficial to patients suffering from conditions such as cardiovascular disease. Aspirin should be considered as a clopidogrel alternative when it hasn’t been tried prior to clopidogrel treatment.

Other drugs such as dipyridamole and glycoprotein IIb/IIIa antagonists should only be considered as a clopidogrel alternative if aspirin and clopidogrel have both been shown to be ineffective in a particular case. The precise action of dipyridamole isn’t fully known, but it appears to work by preventing platelets from being stimulated by ADP — similar to clopidogrel. The drug isn’t suitable for patients with unstable angina, coronary artery disease, and obstructions to the left ventricular outflow. Glycoprotein IIb/IIIa antagonists such as abciximab are administered intravenously and should only be taken under supervision of a medical professional. They work by stopping the surrounding platelets from being stimulated at the IIb/IIIa receptor.

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Discussion Comments
By anon312923 — On Jan 09, 2013

My first questions were:

1. How can I test if my Plavix dosage is sufficient?

Answer from all cardiologists was, you can't.

Then came other questions:

2. If they can't measure or check the dosage then why 75 mg? It has to do with some feedback from the action.

The answer was, it is the experience gathered through the years. Then by what measuring means? Does one have to drop dead to tell he took too low a dosage of Plavix?

3. With no measuring ability, why shouldn't we ask about alternatives to Plavix? How can one tell one medication can do a better job if one can't measure it better, if at all?

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