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The use of the combination of Plavix and aspirin, in those
specific doses, is common for certain conditions, and is
only contraindicated for those with greater sensitivity
toward stomach irritation, such as those patients with
ulcers or a tendency toward gastrointestinal bleeding.
The conditions for which this combination of medications
is prescribed include risk of cardiovascular death, stroke,
myocardial infarction (heart attack), or refractory ischemia.
At the bottom of this page from RXlist.com are the results
of a study called CURE, in which the combination of aspirin
and Plavix was tested against the combination of aspirin and
a placebo. The results indicated a significant risk reduction
for the conditions noted above, particularly for myocardial
infarction. See Figure 2 and 3:
http://www.rxlist.com/cgi/generic/clopidog_cp.htm#CS
Table 3, on the following page, shows the increased risk
of stomach bleeding when aspirin and Plavix are used in
combination, in contrast to aspirin alone:
http://www.rxlist.com/cgi/generic/clopidog_ad.htm#AR
The findings are summarized at the beginning of this page
from the same site:
"In patients with recent TIA or stroke who are at high risk
for recurrent ischemic events, the combination of aspirin
and Plavix has not been shown to be more effective than
Plavix alone, but the combination has been shown to
increase major bleeding.
GI Bleeding: In CAPRIE, Plavix was associated with a rate
of gastrointestinal bleeding of 2.0%, vs. 2.7% on aspirin.
In CURE, the incidence of major gastrointestinal bleeding
was 1.3% vs. 0.7% (Plavix + aspirin vs. placebo + aspirin,
respectively). Plavix should be used with caution in
patients who have lesions with a propensity to bleed (such
as ulcers). Drugs that might induce such lesions should be
used with caution in patients taking Plavix.
Use in Hepatically Impaired Patients: Experience is limited
in patients with severe hepatic disease, who may have
bleeding diatheses. Plavix should be used with caution in
this population.
"Use in Renally-impaired Patients: Experience is limited in
patients with severe renal impairment. Plavix should be used
with caution in this population."
http://www.rxlist.com/cgi/generic/clopidog_wcp.htm
The following PDF file from the East Lancashire Medicines
Management Board in the United Kingdom gives information
about conditions for which Plavix is recommended in
combination with aspirin, at the bottom of page 1, which
include the risk of myocardial infarction and non-ST
segment elevation acute coronary syndrome (NSTEMI ACS):
http://www.elmmb.nhs.uk/Clopidogrel%20policy%20v82.pdf
In summary, 75mg is the standard dosage for ongoing use
of Plavix, and 81mg is the lowest dosage of aspirin used
in combination with Plavix. There's no reason to consider
these dosages to be too high unless you are experiencing
unpleasant side effects - particularly gastrointestinal
bleeding or discomfort. There are also some conditions
which recommend the discontinuation of Plavix after 12
months, such as the non-ST segment elevation acute
coronary syndrome (NSTEMI ACS) noted above, while for
other conditions, the continuation of both is acceptable.
Only your physician can make that determination, depending
on the nature of your condition(s).
If you are *feeling* that the combination currently amounts
to too much medication, then you should feel perfectly
entitled to request a review of your prescription by your
primary care physician or a specialist of his recommendation.
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