Clopidogrel for blood clots, natural alternatives to the use of this blood thinning drug by Ray Sahelian, M.D.
April 10 2015

Clopidrogrel, an "anti-platelet" agent, is marketed by Sanofi-Aventis and Bristol-Myers Squibb. Clopidrogrel was launched in 1998. It is currently marketed in over 80 countries. There are natural alternatives to this medication, see blood clot, that could work just as well, and safer.


Cardiologists are re-evaluating how they prescribe Clopidrogrel, a popular heart medication used to prevent blood clots, after a major clinical study found the drug may cause dangerous bleeding in patients who take it along with aspirin to ward off a first heart attack. Some people taking the blood thinner Clopidrogrel on top of aspirin to try to prevent heart attacks, as many doctors recommend, now have good reason to stop. The Clopidrogrel and aspirin combination not only didnít help most people, but it unexpectedly almost doubled the risk of death, heart attack or stroke for those with no clogged arteries but with worrisome conditions like high blood pressure and high cholesterol.


Clopidrogrel or Aspirin?
Clopidrogrel is commonly used to prevent blood clots, but is aspirin a cheaper way to prevent a blood clot? Is it being used by doctors mostly because of a major marketing push? Clopidrogrel is distributed by Sanofi-Aventis, a French drug manufacturer, and Bristol-Myers Squibb of New York. Clopidrogrel is Sanofi-Aventis's top-selling drug.

Clopidrogrel Prescription

This medication is one of the world's top-selling drugs. It is prescribed with the intention that it may prevent strokes and heart attacks in patients at risk for these problems. Clopidrogrel is in a class of medications called antiplatelet drugs. It apparently works by helping to prevent harmful blood clots. For patients with drug-eluting stents who are event-free at six months follow-up (have not had subsequent cardiovascular events or procedures), the extended use of clopidogrel is associated with a reduction in risk for death or heart attack (myocardial infarction) through 24 months after stent implantation. January 10, 2007 issue of JAMA.


Cardiovasc Diagn Ther. 2013. High residual platelet reactivity on clopidogrel: its significance and therapeutic challenges overcoming clopidogrel resistance. Over the last decade, dual antiplatelet therapy has been the mainstay of the management of Acute Coronary Syndrome, with clopidogrel therapy providing clear benefits over aspirin monotherapy and becoming the agent of choice for the prevention of stent thrombosis. While newer antiplatelet agents have now become available, clopidogrel is still widely used due to its low cost and efficacy. However, many patients still experience recurrent ischemic events. A poor response of the platelets to clopidogrel, called High Residual Platelet Reactivity (HRPR), has been incriminated to account for this dilemma. Despite the absence of a universal definition of HRPR or the gold standard test to quantify it, persistent high platelet reactivity has consistently been associated with recurrence of ischemic events. Clopidogrel metabolism is highly variable, and genetics, comorbidities and drug interactions can affect it. In this article we review all definitions of HRPR, explore the available tests to quantify it, the clinical outcomes associated with it, as well as strategies that have shown success in overcoming it.


Clopidrogrel in Germany

German health insurers, under pressure to cut costs amid reforms, are considering whether to restrict prescription guidelines for Sanofi-Aventis's blood thinner Clopidrogrel in a move that could harm the drug's sales. The Joint Committee (B-GA), the self-regulating body of German health insurers is reviewing a report it had commissioned from an independent research institute which questions the benefits of Clopidrogrel for certain patients. The German Institute for Quality and Efficiency in Healthcare (IQWiG) said Clopidrogrel or Iscover, offered no benefits over aspirin when used alone as a preventative treatment for conditions resulting from arterial diseases. Sanofi-Aventis, the world's third biggest drugmaker, criticised the institute's report.


Drug interactions
Clopidogrel affects the pharmacokinetics of cerivastatin, repaglinide, ferulic acid, sibutramine, efavirenz, and omeprazole. Low efficacy of clopidogrel is anticipated in the presence of omeprazole, esomeprazole, morphine, grapefruit juice, scutellarin, fluoxetine, azole antifungals, calcium channel blockers, sulfonylureas, and ritonavir.

2006 - Clopidrogrel has been approved for patients who have had a type of heart attack called acute ST-segment elevation myocardial infarction (STEMI), who are not going to have coronary artery repair (angioplasty). A STEMI is a severe heart attack caused by the sudden, total blockage of an artery. In STEMI patients, Clopidrogrel prevents subsequent blockage in the already-damaged heart vessel, which could lead to more heart attacks, stroke - and possibly death. FDA approved Clopidrogrel in November 1997 to decrease platelet function in people who suffer from acute coronary syndrome (ACS). Platelets are the sticky blood cells that help to form a clot and can contribute to blocked coronary arteries. According to the American Heart Association, each year an estimated 500,000 Americans have a STEMI heart attack.


2006 - A Bristol-Myers Squibb executive entered a secret side deal with a generic drug maker in hopes of preserving a lucrative monopoly over the anti-clotting drug Clopidrogrel. Those allegations are thought to be the focus of a Department of Justice investigation of Bristol-Myers and the companyís marketing partner for the drug, Sanofi-Aventis. The court filing, made by lawyers for the Canadian generic drug company Apotex, contends that Bristol-Myers made the secret agreement as part of a proposed patent lawsuit settlement with Apotex. The secret deal, Apotex contends, was an effort to evade the scrutiny of the federal and state regulators who were reviewing the settlement. The filing alleges that Dr. Andrew G. Bodnar, a top assistant to Bristol-Myersís chief executive, Peter R. Dolan, negotiated the secret deal after regulators objected to an earlier version of the patent settlement on the ground that it would stifle competition. Although the Food and Drug Administration approved Apotexís generic version of Clopidrogrel in early 2006, the settlement would have delayed the introduction of that drug until 2011, several months before the expiration of the Clopidrogrel patent.


2006 - Canadian drugmaker Apotex Corp. launched a generic version of Bristol-Myers Squibb Co.'s blockbuster Clopidrogrel anti-clotting medicine, threatening Bristol-Myers' earnings outlook and dividend.


2006 - Sanofi-Aventis shares surged after the French drugmaker settled a dispute with generic rival Apotex Inc. that could keep U.S. patent protection on its multibillion-dollar blood thinner Clopidrogrel until 2011.

Clopidrogrel Side Effects
Serious side effects of Clopidrogrel include bleeding and, rarely, low white blood cell counts or thrombotic thrombocytopenic purpura (low platelet counts with spontaneous bleeding and clotting).


Dr. Sahelian's Opinion
I prefer to stick with aspirin at this time since, in my opinion, Clopidrogrel is very expensive and I have not seen enough proof that it is significantly superior to aspirin.


Q. I had a carotid operation for plaque and have been on Clopidrogrel 75 mg since then. i have several diabetic related symptoms for which I take various supplements such as Omega 3, Vitamin E, Garlic, etc. Is there a danger of bruising or bleeding? How do I keep taking the supplements without subjecting myself to excessive bleeding or bruising possibility?
     A. Several supplements decrease coagulation of blood. It is the responsibility of your physician who prescribes the Clopidrogrel to discuss this matter to you in order to avoid excessive bruising or bleeding. There is a possibility that a lower dose of Clopidrogrel may be needed if individuals consume certain herbs or more flavonoids and plant substances.