Platelets are blood cells
that are help the blood clot (stick together) and prevent
bleeding. When the body has a cut, scratch, bruise or
bleed, platelets go into action and begin to work. They
can be thought of as materials (like bricks or blocks)
that aggregate (link together or stack up) to form this
clot. These platelet cells need thromoxane A2 and adenosine;
vitamin K specific clotting factors (chemicals produced
by the body) to make them stick together. These chemicals
are essentially the glue that holds the blocks together
to make the clot. However, in patients who have had
a TIA or stroke, the blocks don’t need to stick together
as much because this causes the blood to be too thick
(like adding flour to milk when making a cake batter)
and possibly form a clot that can’t fit through the
vessels.
Doctors often place stroke
and TIA patients on blood thinners to decrease the possibility
of the body forming another clot in the blood, which
may lead to another stroke and TIA. Below is information
on specific types of antiplatelets used for stroke prevention:
Aspirin (acetylsalicylic acid, ASA)
Besides relieving pain, fever and inflammation, aspirin has many other uses.
Aspirin is also used as an antiplatelet/platelet aggregation
inhibitor (to keep your blood from sticking together)
in patients who have had a TIA or stroke. It can also reduce the risk of having another TIA or stroke.
Different doses are used for this purpose, ranging
from 50mg to 325mg/day, depending on the patient’s
condition and the doctor’s decision.
The idea that
“if one is good for me, two or three must be better"
is wrong. Do not adjust your dose without first talking
to the pharmacist or doctor that dispensed or prescribed
the medication. The dose is not the same for everyone.
The usual dose for stroke/TIA prevention is 30-325mg
a day. Take the medication the way the doctor instructs
you to. So, even though you may be taking an 81mg
(baby aspirin) a day, someone else who had a stroke
may be taking 325mg of aspirin a day or may be on
a different medicine for stroke prevention. So don't rely on what you hear from other stroke patients, and don't
take more or less of the drug without first talking
to the doctor who prescribed it.
Since aspirin can irritate the
stomach, it is best to take it with food or a full glass
of water or milk to help avoid or lessen possible stomach problems.
This medication will help
prevent platelets (glue like particles) from making
the blood too thick, thereby risking a clot. Therefore, it will lessen your body’s ability to stop bleeding when you are cut, scratched, or bruised. Your doctor wants the aspirin to thin the
blood (decrease the body’s ability to form a clot)
just enough to help prevent a future TIA or stroke. Watch
for blood in the urine, stools, or around the gums when eating and brushing teeth; bleeding
from the nose; or easy bruising. If you notice abnormal
or excessive bleeding, let your pharmacist and doctor
know, and talk with them before you change or take
any new medicines.
Abdominal (stomach area)
pain that will not go away and ringing in the ears
are other signs that there might be a problem with
the medication. Let the pharmacist or doctor know
if you have any of these warning signs.
Talk with your pharmacist
or doctor before taking any other aspirin products,
anti-inflammatory agents (Aleve, Naprosyn, Ibuprofen,
etc…) or any other medications.
Clopidogrel
(Plavix®) is an antiplatelet/platelet aggregation
inhibitor drug that is used to help prevent another
stroke. It does this by decreasing the blood’s ability
to clot (clump together). This means that when you
get a cut or scratch it will take a little longer
to stop bleeding. Watch for blood in the urine, blood
in the stools, bleeding around the gums when eating
and brushing teeth, bleeding from the nose, or bruising
easily. If you notice abnormal or excessive bleeding,
let your pharmacist and doctor know, and talk with
them before you change or take any new medicines.
You will take one 75mg
tablet once a day in the morning (can be taken with
or without food), or when and how your pharmacist
and doctor tell you. Do not adjust the dose without
first talking to the pharmacist or doctor that dispensed
or prescribed the mediation, and be sure to talk with
your pharmacist or doctor before taking any other
medications.
Aggrenox
is the combination of, aspirin (25mg) and extended
release dipyridamole (200mg), two antiplatelet/platelet
aggregation inhibitors. Each of these medications
work together in similar way (but on separate chemicals
in the blood) to help prevent a future TIA or stroke.
Do not adjust the dose without first talking to the
pharmacist or doctor that dispensed or prescribed
the medication. The aspirin portion of the combination
works in the same way as above, but the dirpyridamole
helps prevent platelets, blood cells and the vessels
from using adenosine (another chemical that helps
the bricks and glue form a clot). Dipyridamole also
has the potential to vasodilate the vessels that carry
the blood to allow a more blood and particles to flow
through (like a water hose expanding in the summer
sun).
The combination capsule
Aggrenox® (aspirin and dipyridamole) cannot be substituted
by taking each drug separately. Taking the two separately
does not have the desired effect as the combination
capsule does.
Take one capsule in the
morning (with or without food) and take one capsule
in the evening (with or without food) for a total
of two capsules a day. Swallow the capsule. Do not
chew it or crush it. It must be swallowed whole. Take
the medication the way the pharmacist and doctor told
you.
Many patients starting
on Aggrenox® develop a severe headache due to the
vessels in the brain vasodialating (expanding). This
headache tends to decrease and go away as the body
gets use to the medicine. In the mean time use an
over-the-counter pain reliever and call the pharmacist
or doctor to inform them of the headache.
The combination of aspirin
and dipyridamole is a stronger blood thinner than
either drug alone. So, watch for blood in the urine,
blood in the stools, bleeding around the gums when
eating and brushing teeth, bleeding from the nose,
or bruising easily. If you notice abnormal or excessive
bleeding, let your pharmacist and doctor know, and
talk with them before you change or take any new medicines.
Talk with your pharmacist
or doctor before taking any other aspirin products,
anti-inflammatory agents (Aleve, Naprosyn, Ibuprofen,
etc…) or any other medications.
Ticlid®
is used to help prevent another stroke. You will take
a 250mg tablet two times a day (one in the morning
and one in the evening) with food. Take the medicines
like the pharmacist and doctor told you, and do not
adjust the dose without first talking to the pharmacist
or doctor that dispensed or prescribed the mediations.
Be especially observant of any excessive bleeding
such as blood in the urine, blood in the stools, bleeding
around the gums when eating and brushing teeth, bleeding
from the nose, or bruising easily. If you notice abnormal
or excessive bleeding, let your pharmacist and doctor
know, and talk with them before you change or take
any new medicines.
You will have to have
lab work done every two weeks for the first three
months of treatment to check your blood levels. Talk
with your pharmacist or doctor before taking any other
aspirin products, anti-inflammatory agents (Aleve,
Naprosyn, Ibuprofen, etc…) or any other medications.
This page authored by
Chad Mosely and Susan Fagan, University of Georgia College
of Pharmacy.
Last Updated:
March 19, 2007
Important: The
information on this page is for educational use only.
This site does not provide treatment information and
cannot endorse the sites we link to. Always discuss
medication issues with your physician or other health
care provider.
The information contained in this
web site is not a substitute for medical advice or treatment.
Consultation with your doctor or health care professional is recommended.
About Stroke
Clopidogrel
(Plavix®) is an antiplatelet/platelet aggregation
inhibitor drug that is used to help prevent another
stroke. It does this by decreasing the blood’s ability
to clot (clump together). This means that when you
get a cut or scratch it will take a little longer
to stop bleeding. Watch for blood in the urine, blood
in the stools, bleeding around the gums when eating
and brushing teeth, bleeding from the nose, or bruising
easily. If you notice abnormal or excessive bleeding,
let your pharmacist and doctor know, and talk with
them before you change or take any new medicines.
Aggrenox
is the combination of, aspirin (25mg) and extended
release dipyridamole (200mg), two antiplatelet/platelet
aggregation inhibitors. Each of these medications
work together in similar way (but on separate chemicals
in the blood) to help prevent a future TIA or stroke.
Do not adjust the dose without first talking to the
pharmacist or doctor that dispensed or prescribed
the medication. The aspirin portion of the combination
works in the same way as above, but the dirpyridamole
helps prevent platelets, blood cells and the vessels
from using adenosine (another chemical that helps
the bricks and glue form a clot). Dipyridamole also
has the potential to vasodilate the vessels that carry
the blood to allow a more blood and particles to flow
through (like a water hose expanding in the summer
sun). 
Ticlid®
is used to help prevent another stroke. You will take
a 250mg tablet two times a day (one in the morning
and one in the evening) with food. Take the medicines
like the pharmacist and doctor told you, and do not
adjust the dose without first talking to the pharmacist
or doctor that dispensed or prescribed the mediations.
Be especially observant of any excessive bleeding
such as blood in the urine, blood in the stools, bleeding
around the gums when eating and brushing teeth, bleeding
from the nose, or bruising easily. If you notice abnormal
or excessive bleeding, let your pharmacist and doctor
know, and talk with them before you change or take
any new medicines.
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