Plavix for AFib: When it may be prescribed

In this article:

• What is Plavix prescribed for?
• Is Plavix for atrial fibrillation (AFib)?
• Benefits and drawbacks of Plavix for AFib
• Plavix side effects and risks
• Plavix alternatives for AFib

In this article

• What is Plavix prescribed for?
• Is Plavix for atrial fibrillation (AFib)?
• Benefits and drawbacks of Plavix for AFib
• Plavix side effects and risks
• Plavix alternatives for AFib

Atrial fibrillation is a common heart rhythm problem or arrhythmia that can increase the risk of a stroke. When the heart isn’t beating as it should, blood clots might form, sometimes heading straight to the brain. That’s why a blood thinner like Plavix (clopidogrel) might be prescribed off-label, to keep blood clots from forming. However, it’s not usually a go-to for stroke prevention since other, more effective anticoagulants are available. Figuring out when Plavix makes sense means weighing its benefits and risks, and seeing how it compares to other blood thinners.

What is Plavix prescribed for?

Plavix is an antiplatelet drug that’s prescribed to prevent dangerous clots. It doesn’t work quite like classic blood thinners such as Coumadin (warfarin) or Eliquis (apixaban). Instead, it works by blocking a specific receptor on platelets called P2Y12. As a P2Y12 inhibitor, it prevents platelets from clumping together and forming harmful clots.

Plavix is approved by the Food and Drug Administration (FDA) for the following:

• Prevention of heart attacks and strokes in people with acute coronary syndrome (ACS), which includes conditions like chronic chest pain (unstable angina)
• Prevention of heart attacks and strokes in people after a recent heart attack or stroke, and in people with peripheral artery disease

Plavix is sometimes given to people who have had a stent (percutaneous coronary intervention) placed in their heart. After a stent is put in, a person will typically need dual antiplatelet therapy with Plavix and aspirin to keep that stent open. Otherwise, there’s a higher risk of clots forming at the stent, which could lead to a stroke. 

Other off-label uses of Plavix include:

• Reducing stroke risk in people with AFib who can’t take other blood thinners
• Preventing clots after bypass surgery (coronary artery bypass grafting or CABG)
• Managing carotid artery disease, which can affect blood flow to the brain
• Preventing clots after angioplasty or stent placement in peripheral arteries
• Supporting recovery after valve procedures, like mitral valve repair (MV TEER) or aortic valve replacement (TAVI), often in combination with aspirin

Although these uses aren’t FDA approved, a healthcare provider might recommend Plavix based on supporting data from clinical trials.

Is Plavix for atrial fibrillation (AFib)?

Plavix isn’t usually the first thing healthcare providers reach for when treating AFib since it doesn’t do the best job at preventing strokes from AFib compared to other anticoagulants, like direct oral anticoagulants (DOACs). It may also come with a higher risk of bleeding than other blood thinners that are often more effective for AFib. 

Still, Plavix may sometimes be prescribed for AFib if a person isn’t able to take another blood thinner due to drug interactions or other problems. The ACTIVE A trial looked at how well clopidogrel could lower the risk of stroke when used together with aspirin. The results found that dual antiplatelet therapy with clopidogrel and aspirin reduced the risk of strokes more than taking aspirin alone. For every 200 people treated for one year, the combination prevented one disabling or fatal stroke. 

Plavix dosage for AFib

Plavix has a straightforward dosage when it’s used for atrial fibrillation, and it’s the same dosage as those used for its FDA-approved uses. For AFib, healthcare providers typically prescribe Plavix as a 75 mg tablet once daily. That dose stays the same for nearly everyone. There’s no ramp-up or titration; 75 mg is both the starting and max dose. 

Someone who takes Plavix for AFib will generally also take a low-dose aspirin. The usual aspirin dose is 75–100 mg daily while taking Plavix. It’s important to take Plavix exactly as prescribed. The dosage shouldn’t be changed or stopped without consulting a healthcare provider first. 

Those who have surgery planned while taking Plavix will typically need to speak with a healthcare provider in advance. Plavix often needs to be stopped at least five days before a procedure to reduce the risk of bleeding. 

Benefits and drawbacks of Plavix for AFib

While Plavix may offer some perks for people with AFib, it’s not all upside. Taking Plavix may come with some real risks. Here are some of the benefits and drawbacks of using Plavix for AFib.

Benefits of Plavix for AFib

• It may be a good option for those who can’t tolerate or have contraindications to other blood thinners.
• It may help reduce stroke risks in people with AFib, especially when combined with aspirin.
• There aren’t any significant food interactions, unlike with warfarin.
• It doesn’t require frequent follow-up visits to check international normalised ratio (INR) values or other blood tests.
• It may be cheaper than other brand-name medications and is also available as a generic drug.

Drawbacks of Plavix for AFib

• It may not be as effective as other blood thinners for stroke risk reduction in AFib.
• It still comes with an increased risk of bleeding side effects, including stomach bleeding or even life-threatening hemorrhages in the brain.
• It’s not FDA approved for AFib, which means a healthcare provider will need to prescribe it off-label for this purpose.
• It’s typically taken with aspirin, which could increase the pill burden for a person with AFib, especially if they take other medications for other conditions.
• Because it would be prescribed off-label for AFib, it might not be covered by health insurance plans.

For high-risk AFib patients, a healthcare provider will probably recommend a different blood thinner that works better for stroke prevention. Plavix might come into play only when those other medications aren’t a safe option.

Plavix side effects and risks

Plavix can come with a handful of side effects that should be kept in mind. The usual ones include bruising, bleeding, and sometimes a bit of itching. 

Common side effects of Plavix include:

• Bleeding that takes longer to stop 
• Easy bruising on skin 
• Nosebleeds 
• Blood in urine 
• Itching or rash 

The biggest risk with Plavix is a hemorrhage. Since this medication keeps blood clots from forming like they normally would, a person might see red or black stools, cough up blood, or struggle with bleeding that doesn’t seem to stop. These symptoms need emergency medical attention.

Apart from serious bleeding risks, Plavix may come with other warnings. For example, it may cause a rare condition called TTP (thrombotic thrombocytopenic purpura) that causes small blood clots to form throughout the body and needs urgent treatment. In addition, those who have had a bad reaction to medications in the same drug family may also react to clopidogrel. 

Some medications can interact with Plavix, making it less effective or increasing bleeding risks. These medications include:

• Omeprazole or esomeprazole: These acid reducers can reduce Plavix’s effectiveness by blocking the enzyme that activates it.
• Other blood thinners: Taking other drugs with blood-thinning effects, like warfarin, DOACs, nonsteroidal anti-inflammatory drugs (NSAIDs), and certain antidepressants like SSRIs and SNRIs, can increase the risk of major bleeding events along with Plavix.

It’s important to tell your healthcare provider about other prescription drugs, over-the-counter medicines, and herbal supplements before you start taking Plavix.

Plavix alternatives for AFib

The American Heart Association (AHA) and American College of Cardiology (ACC) both point to other medications first before trying Plavix for AFib. DOACs generally do a much better job than Plavix at preventing strokes in AFib. These Plavix (clopidogrel) alternatives work by directly blocking specific proteins called clotting factors to reduce the risk of dangerous clots forming.

The following DOACs are FDA approved to treat AFib in the U.S.:

• Eliquis (apixaban)
• Xarelto (rivaroxaban)
• Pradaxa (dabigatran)
• Savaysa (edoxaban)

In addition, warfarin, an older medication, may be a better option than Plavix for AFib. It works as a vitamin K antagonist that blocks blood-clotting factors from being able to use vitamin K. As a result, it interrupts the body’s blood-clotting abilities.  

Studies have shown that warfarin is more effective than dual antiplatelet therapy with clopidogrel and aspirin at preventing strokes and other serious cardiovascular events in people with atrial fibrillation. However, the overall bleeding risk is similar between dual antiplatelet therapy and warfarin.

Overall, guidelines typically recommend one of the DOACs over warfarin since they’re effective, don’t need frequent blood tests, and may have fewer side effects.

Bottom line

Plavix can be used off-label for atrial fibrillation, but it’s not the preferred choice. While it can help prevent blood clots that can cause a stroke, it’s not usually as effective as warfarin or DOACs like Eliquis and Xarelto. It also still carries a risk of bleeding problems and needs to be taken with aspirin daily. The right medication will depend on risk factors like age, other health problems, and other medications being taken. Therefore, it’s always recommended to consult a healthcare provider for medical advice on the best treatment option.