My mom has had a heart attack 20 yrs ago , heart surgery 15 years ago and three strokes 10 years ago,6years ago and 2 years ago. Her doctor told her today that she had had a mini stroke the day before. He said she would have more and needs to go on PLAVIX. One of her strokes she had before was a bleeding stroke. The doctor told her then not to take anything that might thin her blood. Should my mom be taking PLAVIX if she has had a bleeding stroke? The doctor said that there was a high risk that if she had another bleeding stroke that they might not be able to get the bleeding to stop. He also told her if she didn’t take PLAVIX that she would continue to have more mini strokes. Which is worse the risk of having a bleeding stroke that they can’t stop or the possibility of having more mini strokes?

Doctor Joshua’s Answer:

Plavix (clopidogrel) is usually started when there is so-called ASA failure, which means that there is a stroke despite using aspirin to prevent strokes or TIA (transient ischemic attack, a condition that is like a stroke, but resolves spontaneously within 24h and does not do permanent damage).

If there is a bleeding stroke, it means that first there is a stroke and then the bleeding occurs as a result of the stroke. So, in order to avoid getting a bleeding stroke, the stroke itself must be prevented. This is where the Plavix comes in - it acts to prevent the stroke from happening in the first place, so in effect it also prevents the bleeding stroke from happening.
Since your mother has had several strokes and, if I understand correctly, a recent TIA, it sounds like Plavix treatment may be justified.

Whether your mother needs Plavix or not is not for me to decide, but you should follow her own doctor’s advice. I hope I managed to clarify the issue a little bit here.

There was a significant trial called the MATCH trial in 2004 (see reference), which concluded that aspirin combined with clopidogrel (Plavix) caused an increase in the risk of life-threatening bleeding (not necessarily from a stroke). Therefore it has been recommended that Plavix alone should be used to prevent further strokes, and not both Aspirin and Plavix. However, in practice the decision is made on a patient-by-patient basis, so your mother’s doctor will need to make the decision based on all available information.

Reference:
Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial.

Lancet. 2004 Jul 24-30;364(9431):331-7
Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D,Matias-Guiu J, Rupprecht HJ; MATCH investigators.