Plavix vs Xarelto for blood clots: What’s the difference?

Plavix and Xarelto are brand names for blood thinners used to prevent blood clots. Both are prescription drugs approved by the FDA used for preventing strokes, heart attacks, and death in individuals who have had a previous stroke, unstable angina, heart attack, or have peripheral arterial disease (PAD). Many patients prefer drugs like Plavix and Xarelto, in place of warfarin (Coumadin), which is particularly difficult to manage due to regular blood tests and monitoring intake of vitamin K.

Plavix and Xarelto are both blood-thinning medications that work in different ways to achieve their effect. To help, here we explain clearly and simply what Plavix and Xarelto are, how they work, the similarities and differences between them and their side effects, and more. This should provide you with the basics to better understand your options.

What is Xarelto?

Xarelto contains the active ingredient rivaroxaban. It is a direct-acting oral anticoagulant that works by blocking factor Xa, a fundamental component in the clotting process.

Xarelto is indicated for the following conditions:

• Reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AFib, or irregular heartbeat)
• Prevent deep vein thrombosis (DVT) in the legs and pulmonary embolism (PE) in the lungs of patients who have had hip or knee replacement surgery
• Treatment of deep vein thrombosis (DVT)
• Treatment of pulmonary embolism (PE)
• Reduce the risk of blood clots happening again in people who continue to be at risk for DVT or PE after receiving treatment for blood clots for at least 6 months
• Prevention of DVT, which may lead to PE in patients undergoing knee or hip replacement surgery
• Prevention of blood clots in certain people hospitalized for an acute illness and after discharge, who are at risk of getting blood clots due to the loss of or reduced ability to move around, and other risks for getting blood clots, and who do not have a high risk of bleeding

Xarelto can also be used with aspirin to:

• Lower the risk of cardiovascular death, heart attack, and stroke in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD)
• Reduce the risk of a serious reduction in blood flow to the legs, stroke, major amputation, and heart problems in patients with PAD (a condition where the blood flow to the legs is reduced)

How does Xarelto work?

When your blood clots, it goes through a chemical process that turns it from a liquid to a thick gel. This chemical process is complex and has a number of steps that happen in sequence. Rivaroxaban works by interrupting one of these steps.

When you take Xarelto, rivaroxaban is absorbed into your blood. It attaches itself to and blocks an enzyme in your blood, called Factor Xa. This enzyme controls a step in the clotting process, and by blocking it, rivaroxaban makes it less likely your blood will clot. Another factor Xa drug is Eliquis (apixaban).

How do you take Xarelto?

It comes in tablet form and is taken by mouth. Xarelto is available in four strengths: 2.5 mg, 10 mg, 15 mg, and 20 mg, and your dosage will vary by indication. Xarelto is manufactured by Janssen Pharmaceuticals.

What is Plavix?

Plavix is an antiplatelet drug that specifically inhibits the platelet P2Y12. It is approved by the U.S. Food and Drug Administration (FDA) for the treatment of:

• Acute coronary syndrome – reduces the high risk of myocardial infarction (MI) and ischemic stroke in patients with unstable angina
• Recent MI, recent stroke, or established peripheral arterial disease (PAD)

Plavix can also be used with aspirin to treat heart disease. Plavix contains the active ingredient clopidogrel, which is available as a generic medication.

How does Plavix work?

Plavix belongs to a class of drugs called platelet aggregation inhibitors. Your body uses platelets to help it form blood clots. By blocking the activity of platelets, drugs like Plavix help to prevent your body from making too many clots.

Having your body form blood clots is normally helpful, especially if you’re injured or bleeding. However, in other cases, blood clots can be dangerous.

When clots form inside blood vessels, they can block the flow of blood to your heart, lungs, brain, or anywhere else in your body. This can result in serious conditions such as a heart attack and stroke. Plavix works to prevent these conditions by helping prevent blood clots from forming. Other platelet P2Y12 inhibitor drugs are ticagrelor (Brilinta) and prasugrel (Effient).

How do you take Plavix?

Plavix comes as oral tablets. It’s available in two strengths: 75 mg and 300 mg. The Plavix dosage your doctor prescribes will depend on the type and severity of the condition you are using Plavix to treat.

Plavix and Xarelto and bleeding

Your blood forms clots to plug cuts and injuries, stopping you from bleeding. Because Plavix and Eliquis reduce blood clots, they can increase your risk of bleeding, which can be serious, or even fatal.

You should avoid taking other medications that increase your chances of bleeding with Plavix and Eliqiuis. These include aspirin and other antiplatelet agents, other anticoagulants such as heparin, selective serotonin reuptake inhibitors (SSRIs), antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs), and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.

If you’re taking Plavix or Eliquis and you begin to bleed or you experience symptoms of blood loss, seek urgent medical attention.

Common side effects of Plavix and Xarelto

The most common side effects are related to bleeding for both Plavix and Xarelto, such as:

• Nosebleeds
• Bleeding gums
• Heavier menstrual bleeding
• Unexpected vaginal bleeding

Side effects of Plavix:

• Excessive tiredness
• Headache
• Dizziness
• Nausea
• Vomiting
• Stomach pain
• Diarrhea

Side effects of Xarelto:

• Muscle spasms
• Swelling or joint pain
• Headache
• Rash
• Chest pain or tightness
• Dizziness

Serious side effects that can sometimes occur when taking Plavix and Xarelto can include:

• Serious allergic reactions to the medication. Symptoms include hives, chest pain, and trouble breathing
• Bleeding in your brain and spinal column
• Bleeding in your lungs
• Bleeding into a muscle
• Unusual bleeding
• Vomiting blood that looks like coffee grounds
• Tarry stools

The increased risk of bleeding problems may on occasion turn into major bleeding, causing life-threatening results. Plavix and Xarelto can have side effects, although not everyone will experience them, or have the same ones. Most side effects caused by Plavix and Xarelto are related to increased bleeding, as the medication prevents clotting. Inform your doctor if you are on Plavix or Xarelto before you have any medical or dental procedures or surgery.

This isn’t a comprehensive list of all the side effects Plavix and Xarelto can cause. Side effects depend on the dose you’re taking and the condition you’re taking Plavix or Xarelto for. You can find more details on the side effects in the patient leaflet that comes with your medication.

If you have any concerns about Plavix or Xarelto side effects, talk to your physician, cardiologist, or a pharmacist for medical advice. Also inform your healthcare provider about any medical conditions, supplements, and over-the-counter meds you are taking. You are also encouraged to report side effects to the FDA: visit http://www.fda.gov/medwatch or call 1-800-FDA-1088.

Clopidogrel: an antiplatelet medicine to prevent blood clots

1. About clopidogrel

Clopidogrel is an antiplatelet medicine. It prevents platelets (a type of blood cell) from sticking together and forming a dangerous blood clot.

Taking clopidogrel helps prevent blood clots if you have an increased risk of having them.

Your risk is higher if you have or have had:

• a heart attack
• unstable angina
• a stroke or “mini-stroke” (transient ischaemic attack or TIA)
• peripheral arterial disease
• an operation on your heart or blood vessels, such as a coronary stent insertion

Clopidogrel comes as tablets and is only available on prescription.

2. Key facts

• The usual dose for clopidogrel is 75mg once a day.
• Your doctor may prescribe clopidogrel with or instead of low-dose aspirin.
• The main side effect of clopidogrel is bleeding more easily than normal. You may have nosebleeds, heavier periods, bleeding gums or bruising.
• You can drink alcohol with clopidogrel. But do not drink too much while taking this medicine. It can irritate your stomach.
• You may need to stop taking clopidogrel for a short time before having surgery or dental treatment, but check with your doctor or dentist first.

3. Who can and cannot take clopidogrel

Clopidogrel can be taken by adults aged 18 and over.

Clopidogrel is not suitable for some people. To make sure this medicine is safe for you, tell your doctor if you:

• have ever had an allergic reaction to clopidogrel or any other medicine
• have a stomach ulcer or have had stomach ulcers in the past
• have had bleeding in your brain (a brain haemorrhage)
• have a bleeding disorder, such as haemophilia
• have liver or kidney problems
• are trying to get pregnant, already pregnant or breastfeeding

4.

How and when to take clopidogrel

You’ll usually take clopidogrel once a day, at the same time each day.

You can take clopidogrel with or without food.

Dosage

The usual dose is 75mg a day. Occasionally you may be prescribed a one-off higher dose, such as 300mg or 600mg.

What if I forget to take it?

If you forget to take clopidogrel, take it as soon as you remember.

If you do not remember until the following day, skip the missed dose and take your next dose at the usual time.

Do not take a double dose to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Taking 1 or 2 extra tablets is unlikely to harm you.

But the amount of clopidogrel that can lead to overdose is different from person to person.

Contact your doctor if you have taken some extra tablets and notice any signs of bleeding.

5. Side effects

Like all medicines, clopidogrel can cause side effects, although not everyone gets them.

Common side effects

These common side effects happen in more than 1 in 100 people.

Talk to your doctor or pharmacist if these side effects bother you or do not go away:

• bleeding more easily than normal – nosebleeds, bruising more easily or bleeding that takes longer to stop
• diarrhoea
• stomach pain
• indigestion or heartburn

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

Call a doctor as soon as possible if:

• you’re coughing up blood, or there’s blood in your pee, poo or vomit
• the whites of your eyes turn yellow, or your skin turns yellow, although this can be harder to see on brown or black skin – these can be signs of liver problems
• you feel very tired or have signs of infections, such as a high temperature or sore throat – these can be signs of a blood or bone marrow disorder

Serious allergic reaction

In rare cases, clopidogrel can cause a serious allergic reaction (anaphylaxis).

Immediate action required: Call 999 or go to A&E now if:

• you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you’re wheezing
• you get tightness in the chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of clopidogrel. For a full list, see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

6. How to cope with side effects of clopidogrel

What to do about:

• bleeding more easily than normal – be careful when doing activities that might cause an injury or a cut. Always wear a helmet when cycling. Wear protective gloves when you use sharp objects like scissors, knives, and gardening tools. Use an electric razor instead of wet shaving, and use a soft toothbrush and waxed dental floss to clean your teeth. See a doctor if you’re worried about any bleeding.
• diarrhoea – drink lots of fluids, such as water or squash, to avoid dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
• stomach pain – try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help. If you’re in a lot of pain, speak to your pharmacist or doctor.
• indigestion or heartburn – take clopidogrel a few minutes before or after a meal. If the indigestion does not go away, it could be a sign that you have a stomach ulcer. Talk to your doctor, they may prescribe something to protect your stomach or switch you to a different medicine.

7. Pregnancy and breastfeeding

Clopidogrel and pregnancy

Clopidogrel is not normally recommended in pregnancy, however it can be taken if needed. It is not thought to be harmful to your baby, although evidence is limited.

Talk to your doctor about the benefits and risks of taking clopidogrel. For some conditions, continuing clopidogrel is essential. Do not stop taking clopidogrel unless you have been advised to do so by your doctor.

There may be other treatments that are more suitable for you in pregnancy. Your doctor or pharmacist will be able to advise you.

Clopidogrel and breastfeeding

Only take clopidogrel while breastfeeding if your doctor advises you to.

It is not known how much clopidogrel gets into breast milk, but it’s likely to be a small amount.

If your doctor says it’s OK for you to keep taking clopidogrel, then watch your baby for any possible side effects, such as bruising or bleeding easily. However, it’s unlikely that clopidogrel will cause any side effects in your baby.

Talk to your doctor, pharmacist, midwife, or health visitor if you have any concerns about your baby while you’re breastfeeding.

Non-urgent advice: Tell your doctor if you’re:

• trying to get pregnant
• pregnant
• breastfeeding

8. Cautions with other medicines

Some medicines affect the way clopidogrel works.

Tell your doctor if you’re taking any of these medicines before you start taking clopidogrel:

• medicines to prevent blood clots, such as aspirin, warfarin, rivaroxaban, apixaban, edoxaban, dabigatran, dipyridamole, ticagrelor or prasugrel
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as citalopram
• indigestion medicines called proton pump inhibitors (PPIs), such as omeprazole

Taking clopidogrel with everyday painkillers

Your doctor may prescribe daily low-dose aspirin (75mg tablets) to take together with clopidogrel. Or they may prescribe clopidogrel instead of daily low-dose aspirin if you have problems with aspirin.

Do not take aspirin for pain relief (300mg tablets) or ibuprofen while you’re taking clopidogrel, unless a doctor has said it’s OK. They increase the chance of bleeding.

You can take paracetamol together with clopidogrel.

Taking clopidogrel with indigestion medicines

Indigestion remedies called proton pump inhibitors (PPIs), such as omeprazole and esomeprazole, may reduce the effect of clopidogrel.

If you have indigestion and need a medicine to protect your stomach, your doctor can prescribe you a different PPI, such as lansoprazole.

You can take other indigestion remedies such as antacids at the same time as clopidogrel. Your pharmacist will be able to recommend a suitable indigestion remedy for you.

Mixing clopidogrel with herbal remedies and supplements

There might be a problem with taking some herbal remedies and supplements with clopidogrel, especially ones that can affect your blood (for example, ginkgo).

St John’s wort (used for depression) can increase the levels of clopidogrel in your blood. This can increase your risk of bleeding.

Important:
Medicine safety

Tell your doctor or pharmacist if you’re taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions about clopidogrel

How does clopidogrel work?

Clopidogrel slows the blood’s clotting action by making platelets less sticky. Platelets are blood cells that stick together to block cuts and breaks in blood vessels.

But if you’re at risk of heart attack or stroke, platelets can stick together inside already narrowed blood vessels to form a clot. The clot can stop blood flowing to the heart or brain and cause a heart attack or stroke.

If you take it every day, clopidogrel stops platelets clumping together to form unwanted blood clots. This helps to prevent heart attacks and strokes.

How long does it take to work?

Clopidogrel works within 2 hours of taking it.

When will I feel better?

You may not feel any different after you start taking clopidogrel. However, this does not mean that the medicine is not working.

Carry on taking clopidogrel even if you feel well, as you’ll still be getting the benefits.

How long will I take it for?

You may need to take clopidogrel for a few weeks or months, or you may have to take it for the rest of your life.

Is it safe to take it for a long time?

Clopidogrel is generally safe to take for a long time. In fact, it works best if you take it for many months or even years.

If you’re at risk of getting a stomach ulcer, your doctor may prescribe a medicine to help protect your stomach while you’re taking clopidogrel.

What will happen if I stop taking it?

Do not stop taking clopidogrel without talking to your doctor.

If you stop taking clopidogrel, your blood will start clotting at the same rate as before you started taking it, usually within 5 days of stopping the medicine. This means you may be at increased risk of serious problems like heart attacks or strokes.

Are there any other similar medicines?

Other antiplatelet medicines include low-dose aspirin, dipyridamole and ticagrelor.

Anticoagulant medicines such as apixaban, dabigatran, edoxaban, rivaroxaban and warfarin are also prescribed to prevent blood clots forming.

Not all medicines that prevent blood clots are suitable for everyone.

Talk to your doctor or pharmacist to find out why you have been recommended a particular medicine.

How does clopidogrel compare with other antiplatelet medicines like ticagrelor?

Both clopidogrel and ticagrelor work to:

• prevent blood clots
• prevent future heart attacks, if you have already had a heart attack

But ticagrelor is not approved for preventing further strokes if you have already had a stroke. In this case, your doctor may prescribe clopidogrel instead.

You’ll usually take clopidogrel once a day. Ticagrelor is taken twice a day.

Clopidogrel may be less likely to cause bleeding than ticagrelor.

Can I drink alcohol with it?

Yes, you can drink alcohol while taking clopidogrel, as long as you stick to the national guidelines of no more than 14 units a week for men and women.

A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.

Drinking too much alcohol while you’re taking clopidogrel can irritate your stomach. There’s a risk that you could get a stomach ulcer.

Is there any food or drink I need to avoid?

Do not drink grapefruit juice while taking clopidogrel.

Grapefruit juice decreases the effects of your medicine, so that it may not work as well to prevent clots.

Will I need to stop clopidogrel before surgery or dental treatment?

Because of the risk of bleeding, you may need to stop taking clopidogrel for a short time before having surgery or dental work.

Do not stop taking clopidogrel without first talking to your doctor or dentist. They’ll tell you if you need to stop taking clopidogrel before a procedure.

Can I have vaccinations?

Yes, you can have vaccinations while taking clopidogrel.

It’s a good idea to mention to the doctor or nurse that you’re taking an antiplatelet medicine.

Will it affect my contraception?

Clopidogrel does not affect any type of contraception, including the combined pill and emergency contraception.

Will it affect my fertility?

There’s no clear evidence to suggest that taking clopidogrel will reduce fertility in either men or women.

But speak to a pharmacist or your doctor before taking it if you’re trying to get pregnant.

Will it affect my sex life?

Clopidogrel will not affect your sex life.

Can I drive or ride a bike?

Clopidogrel does not affect your concentration, so you can drive or ride a bike while you’re taking it.

Can lifestyle changes help?

If you have been prescribed clopidogrel, you can also boost your health by making some key lifestyle changes.

• Quit smoking – smoking increases your heart rate and blood pressure. Quitting smoking will cut your risk of heart attack and stroke. Try to avoid secondhand smoke, too.
• Cut down on alcohol – try to keep to the recommended guidelines of no more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
• Exercise – regular exercise keeps your heart and blood vessels in good condition. It does not need to be too energetic, walking every day is enough.
• Eat well – aim to eat a diet that includes plenty of fruit and vegetables, wholegrains, fat-free or low-fat dairy products and lean proteins. It’s a good idea to follow these tips for a lower salt diet too. Aim for no more than 6g of salt a day.
• Deal with stress – when you’re anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This raises your risk of heart attack and stroke. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help keep stress at bay.
• Vaccinations – if you have heart failure, it’s recommended that you have the flu vaccine every year and the pneumococcal vaccine as recommended by your GP.