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Ahmed Abdalbagi: Aspirin vs Plavix – Updated Clinical and Pharmacological Breakdown

Ahmed Abdalbagi/LinkedIn

Feb 5, 2026, 14:48

Ahmed Abdalbagi: Aspirin vs Plavix – Updated Clinical and Pharmacological Breakdown

Ahmed Abdalbagi, SCFHS-Licensed Pharmacist, shared a post on LinkedIn:

“Aspirin vs. Plavix: Updated clinical and pharmacological breakdown:

Drug class and mechanism:

Aspirin (acetylsalicylic acid):
Irreversible cox-1 inhibitor |Antiplatelet + NSAID (anti-inflammatory, analgesic, antipyretic).
Plavix (clopidogrel):
Irreversible P2Y12 ADP-receptor inhibitor | Pure antiplatelet – NO NSAID effects.
Available strengths:
Aspirin: 75mg, 81mg, 100mg, 300mg (varies by indication). Plavix: 75mg (maintenance), 300mg (loading dose).

Key contraindications:

Aspirin: Active peptic ulcer, NSAID-sensitive asthma, bleeding disorders, severe renal/hepatic impairment.

Plavix: Active bleeding, intracranial hemorrhage, hypersensitivity – safe in asthma.

Shared contraindication:

ITP (immune thrombocytopenia) – high bleeding risk.

Critical drug interaction alert – updated guidelines:

Plavix + PPIs: Significant interaction via CYP2C19 inhibition – reduces clopidogrel antiplatelet efficacy.

Avoid: Omeprazole, Esomeprazole.

Preferred PPI if mandatory: Pantoprazole (minimal CYP2C19 effect).

2024 recommendation: Use H2 blockers (e.g., famotidine) or PPI only if strongly indicated.

Primary indications – secondary prevention:

Acute Coronary Syndrome (ACS), MI, Ischemic Stroke, Post-PCI/Stent, Post-CABG.

DAPT (Dual Antiplatelet Therapy): Aspirin + Clopidogrel – duration individualized per bleeding/thrombosis risk.

DAPT Duration Post-PCI: Short-term (3-6 months) for high bleeding risk; extended if high thrombotic risk.

Genetic testing: CYP2C19 loss-of-function alleles – consider for clopidogrel non-responders.

Primary prevention: Aspirin reserved for select high CV risk patients (no routine use).

For all healthcare professionals:

Guidelines align with ACC/AHA and ESC – emphasize personalized antiplatelet therapy.

Hospital and community pharmacists: Screen for ppi interactions, educate on adherence, monitor bleeding signs.

Are you updating your DAPT protocols based on latest guidelines? How do you manage PPI interactions in practice? Tag a colleague who needs to see this.”

Ahmed Abdalbagi: Aspirin vs Plavix - Updated Clinical and Pharmacological Breakdown