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Stroke

TIA prevention

01/22/2007

Question:

I am 51 yrs female pt.I had a TIA on 2000 january,with transient left sidwe hemiparesia.MR was normal(both perfusion and diffusion) but MRA showed occluded right MCA with perfect collateral circulation.I had at that time hypertension and after 2 years I acquired DM type 2.Since 2000 I am on plavix(Aspirin causes gastric discomfort).I have side effects like dizziness,pruritis,back pain,rhinitis,allergic bronchitis,chest pain,edema which I attribute to plavix.I also take metoprolol,olmesartan & metformin.Should I receive antitrombotics lifetime?Can I stop clopidogrel?If so should I receive other antitrombotics?

Answer:

There are currently only a few choices for stroke prevention, and Clopidogrel is the only choice that does not contain aspirin.  There are no guarantees that clopidogrel will prevent a future stroke, but going off of this medication will indeed increase your risk.  Thus, I would recommend lifetime therapy unless there is a specific reason to stop (such as significant side effects of risk for bleeding).

As to the side effect list, I would recommend that you discuss this thoroughly with your physician.  It seems very unlikely to me that all the symptoms you listed are related to clopidogrel use, and some might need further evaluation. 

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Response by:

Brett   Kissela, MD Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati