The potential problem is that if the metabolising enzyme for clopidogrel is not functioning (CYP2C19) it will not be apparent, and the NHS do not screen for it. I recently pointed out, that trial participants were not being screened for CYP2C19 loss of function or rapid function, where the administered drug is metabolised by CYP2C19. I was told that the NHS don’t screen for it (aagh!)
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I think everybody (NICE standard) gets put on aspirin (possibly with clopidogrel) immediately after a stroke. Around 80% of stokes are ischaemic (clot) and 20% are haemorrhagic (bleed). That gets a bit complicated if you have a haemorrhagic transformation (HT) after the stroke, where there is bleeding into the stroke-damaged area of the brain. Although I had an ischaemic stroke, I subsequently had an HT. The two attending GPs didn’t recognise the classic symptoms of a subarachnoid event. I was that and the one-hour delay by the ambulance paramedics who didn’t know that an absence of FAST indicators is not an absence of a stroke, that encouraged me to join Stroke Voices in Research and Stroke Association Research.
Generally, if you have an ischaemic stroke that may be related to atrial fibrillation, the long-term management will be an anticoagulant such as dabigatran (Pradaxa). If it’s haemorrhagic, the long-term management will be an antiplatelet such as clopidogrel, although there is an alternative to clopidogrel.
Although I had asymptomatic AF, that may not have directly caused my stroke. Two days beforehand, I had my usual one hour hard workout in the gym, followed by a 15 minute warm down that included yoga stretches. Those ended with a series of inverted poses - shoulder stand, candle, plough, knees to ears. It’s possible that the gym session plus my neck at right angles to my trunk, had loosened plaque in the carotid artery that made its way to my brain. My brilliant Neurologist told me that she had treated someone who had a stroke in a yoga class.
I’ve just read the NICE guidance that mentions using Omeprazole if the patient suffers from dyspepsia. However, Omeprazole is also metabolised by CYP2C19.
On the subject of drugs that are metabolised by CYP2C19, I respond quickly and very well to Diazepam, but selective serotonin reuptake inhibitors really wind me up so I can’t take them. What’s the chance that I have an ultra-rapid response? After all, I was one of the 6 in 100,000 whose lungs have a bad reaction to dronedarone and amiodarone.
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It’s interesting talking to academics about studies and trials for stroke procedures. I have twice read protocols where the person who has had a stroke (or the next of kin) is asked to read an explanation of the procedure, then sign a form that you’ve read it and fully understood it! Most of us in a full stroke don’t know what’s happened or who we are, let alone understood what we are given to read. Additionally, 70% of people immediately after a stroke have a visual disability. It’s much like when I had peritonitis: sign the consent form or …
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I had an ischaemic stroke, no atrial fibrillation, , and consultant put me on Clopidogrel, an anti platelet , for life. Surprised you think I should be on an anticoagulant? He was the main Professor at the large teaching hospital I was treated at. Hope he knows his stuff!!
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I’m not surprised that you were prescribed clopidogrel, as you didn’t have atrial fibrillation. In you re-read my second paragraph, an ischaemic stroke related to atrial fibrillation is likely to have long term management with an anticoagulant. It follows that an ischaemic stroke not related to atrial fibrillation will be treated with an antiplatelet.
It’s better if people describe their condition in full. On a separate forum about stroke, someone wrote they had a fall that had caused hemianopia. It transpired that she had fallen off a horse, not had a fall because of a stroke.
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Hello, sorry to reply to an old message. I’ve just read your thread re. Clopidogrel, as I found it when I was searching for some information on the medication. You are right that there is a genetic blood test that can determine if the drug works for each individual. I live in Scotland and had a BRAO (eye stroke) three weeks ago. I had the genetic test and the results are that the drug is suitable for me. The blood test was developed at Ninewells Hospital in Dundee, and is currently being rolled out to other health boards in Scotland. There is a lot of information online about the test being developed at Ninewells. I hope this is of interest to you.
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Hello @Islagirl - It’s perfectly fine to reply to old messages.
In this case you found this message and felt the information you had to share is relevant to the post, so it makes perfect sense to reply as you did. Importantly, you have given new some information about a blood test that the original poster @Ginny2 was looking for.
You just never know Ginny2 might still be looking and now you have helped by adding this information. Also, just as you did, others may come along in the future and read this post and of course your information will be totally relevant and available immediately.
Well done and thank you.
Take care.
Namaste|
Thank you for your kind comments.
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Yep very interesting post. Just want to add my thanks to that of ManjiB. As a Clopidogrel user it’s of great interest. For the moment all I can say is……… so far so good 
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Hi @Trace57 i hope you don’t mind me asking, by it which foods are a problem with Clopidogrel? I’ve just started on it after a BRAO and didn’t know this….
Hello @Beeby31 - I am aware of warnings to not eat grapefruit with on clopidogrel.
If you have the information leaflet that comes with the medicine, there will be a section that offers advice on this. Most medicines come with information leaflets and also you can check on the NHS website, Drugs.com etc.
Below is some information from a Google search.
When taking clopidogrel (Plavix), you should primarily avoid grapefruit and its close relatives, limit alcohol intake, and be cautious with certain herbal supplements. These items can interfere with how the medication works or increase the risk of bleeding.
Foods and Drinks to Avoid or Limit
- Grapefruit and related citrus fruits: Grapefruit, grapefruit juice, Seville oranges (often used in marmalades), pomelos, tangelos, and minneolas should be avoided. They contain compounds called furanocoumarins that can inhibit the liver enzymes needed to activate clopidogrel, making the medication less effective at preventing blood clots.
- Alcohol: Excessive alcohol consumption should be avoided as it can irritate the stomach lining and increase the risk of bleeding when combined with clopidogrel. Limit intake to recommended guidelines (no more than 14 units a week, spread across several days) and discuss your drinking habits with your doctor.
- Highly Processed Foods and High Saturated Fats: While not a direct interaction, a diet high in saturated fats can undermine your cardiovascular health goals and increase the risk of plaque buildup in arteries, counteracting the purpose of the medication.
I hope this helps.
Thanks so much for your message. So thoughtful of you. I did have a Google after the post and fortunately I dislike grapefruit and I’ve completely avoided alcohol this Christmas as still living in fear that anything can tip the health balance at the moment…
Waiting to be referred to haematologist for more investigation.
Happy New Year, new friends. And all the bery best for 2026 
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Hi, I just saw your message while looking for something else, but as I try to limit my medicine and I don’t like clopidolgrel. I will certainly ask my go about this. In that I live in Devon it may take awhile for the NHS to approve it here, if at all. One can only dream.
The test looks for variants to the CYP2C19 enzyme that metabolises clopidogrel and other commonly used drugs such as SSRIs and diazepam. The NHS does not screen for those variants that are present in about 30% of white people, and 60% of people South Asian people. The variants can cause rapid metabolisation or stop it working. There is an NIHR paper on the subject.