Stroke Prevention Medication: Aspirin vs Clopidogrel - Which is best?

Aspirin is available as a prescription and over-the-counter drug. It belongs to the nonsteroidal anti-inflammatory drug (NSAID) class of drugs. It is used widely for various conditions such as relieving pain, swelling, osteoarthritis (a disease where the bones become brittle and soft and can break easily), rheumatoid arthritis (it is a chronic inflammatory disorder that affects the joints of the body), pericarditis (inflammation around the heart), reducing the risk of events in people who are on high risk. Low-dose Aspirin can also reduce the prevention of blood clot formation and help in stroke prevention.

Clopidogrel is also a prescription medication that belongs to the antiplatelet class of medication. It works by preventing clots in the body (clots are formed from the collection of platelets), which causes a heart attack or stroke, thus helping prevent stroke.

Clopidogrel and Aspirin can be used alone or prescribed together or combined with other medications to prevent serious or life-threatening problems related to blood vessels or stroke.

Table of Contents

What is a Stroke? Causes, risk factors, symptoms & signs

Stroke is a condition that occurs when a blood vessel in the brain bleeds or ruptures or when there is a blockage, which causes a reduced supply of oxygen and blood to the brain tissues. If not treated immediately, these tissues are damaged and begin to die within minutes.

Heart stroke causes

Reduced supply of oxygen and blood to the brain causes brain damage to the adjacent tissues of the brain. Stroke symptoms can include:

Slurred speech
Paralysis
Confusion
Disorientation
Trouble speaking
Nausea
Seizure
Dizziness
Paralysis
Trouble understanding
Sudden behavioral changes
Numbness or weakness in the arm, leg, and face (on the one side of the body)
Trouble walking
Loss of balance
Vomiting
Severe headaches without any known cause

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Stroke Risk factors

The following are some of the risk factors that may make you vulnerable to a stroke:

Unhealthy diet (food high in salt, trans fats, saturated fats, and cholesterol)
Heavy alcohol use
Tobacco use
Family history
Age
High blood pressure
High cholesterol
Obesity
Heart valve defects
Diabetes
Clotting disorders
Heavy alcohol use

Heart Stroke Sign & Symptoms

The sign & symptoms of a heart attack include:

Shortness of breath
Chest pain or discomfort
Fatigue
Pain in arm, shoulder, or neck
Upper body pain
Trouble in breathing
Dizziness
Sweating
Upper body pain
Nausea

Stroke Treatment & how does medication help?

Treatment of the Stroke depends on the type of Stroke. The treatment includes:

Drugs that can break clots in your brain arteries (Alteplase IV r-tPA – Tissue plasminogen activator). The medication helps in dissolving the clot
Other Medications (medications that reduce blood pressure, diabetes, lower pressure in the brain, prevent seizures, prevent blood vessel constriction)
Medications for managing Stroke (Oral anticoagulants, antiplatelet drugs) help to reduce clots and prevent stroke
Coiling (a procedure that involves using a long tube to the affected area and installing them with a coil-like device in the area where the blood vessel is weak, which causes blocking of the blood flow to the affected area)
Mechanical Thrombectomy (a procedure that involves inserting a catheter into the blood vessel of the brain and using a device that helps to pull the clot out)
Stents (just like in the heart, this procedure can be performed in the brain to dilate the artery and support the walls of the artery)
Surgery (though performed in rare cases when other treatments do not work and when the clots are large)

Aspirin and Stroke prevention

Low doses of Aspirin help to prevent stroke. Usually, your physician will prescribe 75 mg once a day, and sometimes a higher dose (100 mg) may be prescribed. Aspirin prevents blood clots from forming in the arteries by reducing the platelets from sticking together (clumping of the platelets) and preventing them from forming blood clots. Thus, it can help certain people to lower the incidence of stroke. It also helps prevent a second stroke or transient ischemic attack, often considered a warning sign for a stroke.

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Clopidogrel and Stroke prevention

Clopidogrel is more effective than Aspirin in the prevention of recurrent ischaemic stroke. Many studies have proved its efficacy in cerebrovascular disease prevention. Antiplatelet drugs like Clopidogrel are used in both management and prevention of acute ischemic stroke. Clopidogrel reduces stroke incidence in patients at a higher risk, especially those with atherosclerosis and a known history of cerebrovascular disease.

Comparing the two- similarities vs. differences, common side effects & precautions

Similarities

Aspirin and Clopidogrel are used alone or in combination (prescribed together) or with other medications to prevent clot formation in the body, thus can help to prevent from a stroke. Preventing clot formation helps to keep blood flowing smoothly in your body.

Aspirin and Clopidogrel are to be taken orally and once daily. While on treatment with either or both the medication, you must carefully follow the instructions on your prescription label and ask your physician or pharmacist to explain in case of any queries.

Common Precautions

In case if you are on treatment with either or both medications and are planning to get pregnant or are pregnant or breastfeeding, please consult your doctor immediately.

While on treatment with either or both medications, inform your doctor if you have surgery, including dental surgery. You may be advised to discontinue your treatment with the medication to avoid excessive bleeding.

While taking Aspirin and Clopidogrel, you may bleed more easily and for a more extended period than normal. You must take appropriate precautions while on treatment with both or either of the medication.

If you have a history of ulcers, bleeding disorders, kidney or liver disease, you should inform your physician before the treatment begins.

Common side effects

While taking Aspirin or Clopidogrel, or both, you may often experience stomach upset, heartburn, or stomach pain. Also, Abdominal pain, liver damage, cramps, burning sensations are similar side effects of both drugs.

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Differences

Class of drugs: Though both Aspirin and Clopidogrel are used to prevent blood clots and help in preventing stroke. Clopidogrel belongs to the anticoagulant class of medication, and Aspirin belongs to NSAID. Aspirin is available as both prescription (extended released tablet) and non-prescription medication (delayed released tablet). On the other hand, Clopidogrel is available as a prescription medication.

Benefits: Aspirin is used for reducing fever, inflammation (osteoarthritis or rheumatoid arthritis), and pericarditis, soft tissue injuries, Reiter’s syndrome, Ankylosing spondylitis. On the other hand, Clopidogrel is used to prevent strokes, unstable angina, or peripheral arterial disease (reduced blood supply to a part of the body due to narrowing blood vessels).

Side effects: Common side effects of Aspirin include:

Nausea
Stomach pain
Heartburn
Stomach pain

Severe side effects of Aspirin include:

Bloody vomit
Ringing in ears
Fast heartbeat
Loss of hearing
Hives
Rash
Difficulty in breathing
Wheezing

Common side effects of Clopidogrel include:

Headache
Vomiting
Fatigue
Stomach pain
Diarrhea
Nosebleed
Dizziness

Severe side effects of Clopidogrel include:

Liver failure
Allergic reactions
Severe bleeding
Pancreatitis (inflammation of the pancreas)

Stroke Prevention Medication: Aspirin vs Clopidogrel – Which is best?