Anticoagulant Use (Aspirin, Clopidogrel, Warfarin)

Sheldon H. Gottlieb, M.D., Paul A. Pham, Pharm.D.
Anticoagulant Use (Aspirin, Clopidogrel, Warfarin) is a topic covered in the Johns Hopkins Diabetes Guide.

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  • Aspirin: secondary prevention: treatment of transient transchemic attack (TIA) and ischemic stroke; prevent recurrent myocardial infarction (MI); reduce risk of MI or sudden death in unstable angina and chronic stable angina; after angioplasty, coronary artery bypass graft (CABG), carotid endarterectomy.
  • Clopidogrel (Plavix): secondary prevention: acute coronary syndromes (unstable angina, non-ST elevation MI including those who are to be managed with coronary revascularization, ST elevation MI, after MI, stroke, established peripheral vascular disease.
  • Warfarin: secondary indication: prophylaxis or treatment of thromboembolism in atrial fibrillation, mechanical heart valves; reduce risk of stroke or recurrent MI after MI; prophylaxis or treatment of venous thrombosis or thromboembolism in high-risk patients.
  • Dabigatran (Pradaxa): primary and secondary prevention of stroke in non-valvular atrial fibrillation. FDA warning: do not use in patients with mechanical heart valves.
  • Rivaroxaban (Xarelto): primary and secondary prevention of sroke in non-valvular atrial fibrillation; prevention of deep vein thrombosis (DVT) after hip and knee surgery; secondary prevention after DVT and pulmonary embolism.
  • Apixaban (Eliquis): primary and secondary prevention of stroke in non-valvular atrial fibrillation.


  • Aspirin: primary prevention of cardiovascular events in diabetes (see Routine Preventive Care).
  • Clopidogrel (Plavix): primary prevention not established.
  • Warfarin: primary prevention not established.
  • Pradaxa, Rivaroxaban, Apixaban: primary prevention not established. Note FDA warnings re: mechanical heart valves.

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Last updated: September 27, 2013