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Antiplatelet Drugs: Summary of Recommendations

Antiplatelet drugs are used to lower the risk of heart attacks and strokes and to treat people who have artery blockages in their legs. They work by reducing the formation of blood clots, which can lead to heart attacks and strokes.

These medications are widely used, primarily because aspirin is one of them. Your doctor might also refer to them as "blood thinning" drugs. Technically, they don't actually thin the blood; instead, they interfere with an important part of the process by which the blood clots. Namely, they decrease the clumping of blood cells called platelets. This lowers the risk that potentially harmful blood clots will form. Some people might be prone to the formation of such clots. In people whose arteries have narrowed from atherosclerosis—the "hardening of the arteries" that is the basis of coronary artery disease and peripheral artery disease (in the legs and neck, for example)—blood clumping and clotting can become dangerous.

This report evaluates the use of antiplatelet drugs in preventing heart attacks, strokes, and premature death in people who have acute coronary syndrome (unstable angina or had a heart attack), peripheral vascular disease, a stent, or previously had a stroke. Five of these medications are evaluated in this report: aspirin, a fixed combination of aspirin plus extended-release dipyridamole (Aggrenox), clopidogrel (Plavix), prasugrel (Effient), and ticlopidine (Ticlid and generic).

 Taking effectiveness, safety, side effects, and cost into account, we have chosen the following as Consumer Reports Best Buy Drugs if you have any of these conditions:
  • Aspirin – If you have peripheral vascular disease, or had a stroke or ministroke (TIA)
  • Aspirin plus clopidogrel (Plavix) – If you've been diagnosed with acute coronary syndrome (e.g. unstable angina or have had a heart attack), if you've had a stent implanted, or you've had a stroke or ministroke (TIA).
  • Aspirin plus extended-release dipyridamole (Aggrenox) –you've had a stroke or ministroke (TIA).
  • Clopidogrel (Plavix) - If you can't take aspirin and have been diagnosed with acute coronary syndrome or had a stent implanted.

Be sure to ask your doctor about generic clopidogrel, which should become available in the spring of 2012.

This report was published in September 2011.
Antiplatelet Drugs: Drug Comparison
CR Best Buy Generic Name and Dose Brand NameA Frequency of Use Per DayB Average Monthly CostC Best Buy Indication Compare Prices
Aspirin tablet 81 mg-325 mg Bayer, Bufferin, Others, and Generic One $1E Acute coronary syndrome, or if you have a stent or peripheral vascular disease, or had a stroke or ministroke (TIA).
Aspirin/dipyridamole sustained-release capsule 25 mg/200 mg Aggrenox Two $247 If you've had a stroke or ministroke
Clopidogrel tablet 75 mgD Plavix One $214 Acute coronary syndrome, or if you have a stent, or if you've had a stroke or ministroke (TIA)
  Prasugrel tablet 10 mg Effient One $222  
  Prasugrel tablet 5 mg Effient One $231  
  Ticlopidine tablet 250 mg Generic Two $64  
A. "Generic" indicates that this drug is sold as a generic.

B. Frequency of use reflects usual frequency; some products might be used more or less frequently.

C. Prices (except for aspirin) reflect nationwide retail average for April 2011, rounded to the nearest dollar; prices are derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer

Pharma Solutions, which is not involved in our analysis or recommendations.

D. Generic clopidogrel is expected to become available the spring of 2012.

E. Average aspirin prices were calculated by Consumer Reports Best Buy Drugs using prices obtained from nine online drugstore retailers, including: Costco.com, CVS.com, Drugstore.com, Familymeds.com, Healthwarehouse.com, Kroger.com, and Target.com.