Side effects from prolonged use of aspirin may include stomach ulcers and bleeding. (There may be a slight increased risk for bleeding-related strokes, which are very uncommon, however. Furthermore, this risk may be outweighed by protection against the more common type of stroke, which is caused by artery blockage.)
Clopidogrel and Other Thienopyridine. Clopidogrel (Plavix) is an oral platelet inhibitor called a thienopyridine. When taken with aspirin, this drug can significantly reduce the risk for heart attack and stroke in patients with acute coronary syndrome (unstable angina or early signs of heart attack). Clopidogrel is also recommended for patients who are undergoing angioplasty. For patients having coronary bypass surgery, it should be withheld for at least 5 to 7 days prior to surgery because of a significant bleeding risk. Researchers are investigating whether clopidogrel and aspirin together are better than aspirin alone in reducing the risks following coronary bypass surgery.
A 2006 study suggested that for some patients, clopidogrel plus aspirin does not work better than aspirin alone for preventing a first heart attack or stroke in patients with heart disease. However, the drug combination is still recommended for many patients, including those who have angioplasty surgery with stents. Patients who are prescribed clopidogrel should not stop taking the drug without first talking with their doctor.
Ticlopidine (Ticlid) is another effective thienopyridine, but has largely been replaced by clopidogrel because of dangerous blood disorders, particularly thrombocytopenia.
 | Click the icon to see an image of the developmental process of atherosclerosis. |
 | Click the icon to see an image about atherosclerosis. |
Anticoagulants
Anticoagulants are drugs that prevent or delay blood coagulation and the formation of blood clots. Heparin has been the standard anticoagulant, but a number of drugs are now available that are proving to be better choices in many cases.
Standard (Unfractionated) Heparin. The heparin referred to as unfractionated heparin has been the standard for years and is used alone or in combination with aspirin for managing unstable angina. It is no longer the recommended first choice, however, for this patient group. It must be intravenously administered and monitored with frequent blood tests. The major complication is thrombocytopenia (a severe drop in platelets). This condition is extremely serious and can become life-threatening, particularly with bleeding in various body tissues. Alternatives include low-molecular weight heparin and direct thrombin inhibitors.
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