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Best blood thinners to prevent heart attack and stroke

From aspirin to Plavix, find out which drug could help you the most

Published: September 2011

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.

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Editor's Note:

These materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).