Plavix and Aspirin
Together is not Better than Aspirin Alone in Preventing a First Heart
Attack in High Risk Patients with Heart Disease
A new study shows that patients adding Plavix to aspirin does not
prevent first heart attacks in people at high risk. Previous research
has shown the anti-clotting drug Plavix and aspirin to be helpful in
reducing the risk of subsequent heart attacks. It is because of these
earlier findings that many physicians assumed it would help prevent the
initial heart attack.
The researchers studied 15,603 high risk patients who either had been
diagnosed with heart disease or had multiple-risk factors, such as
diabetes, hardening of the arteries, high blood pressure or high
cholesterol. The subjects were from 32 different countries, and were
all over the age of 45. The results were presented at the American
College of Cardiology conference Sunday by Dr. Eric Topol and Dr. Deepak
Bhatt of the Cleveland Clinic.
Aspirin may help prevent a second heart attack in people that have
already had one. The researchers believe that if you have never had a
heart attack, aspirin may not be that useful in preventing one,
according to Christian Nordqvis in Medical News Today.
There was a warning from the Sunday session. Dr. Marc Pfeffer of the
Harvard Medical School and Dr. John Jarcho of the Brigham and Women's
Hospital in Boston said in an accompanied editorial that "The absence of
a clear benefit, in terms of clinical outcome, coupled with the
increased rate of bleeding ... argues against the use of dual
(anti-clotting) therapy in this patient population,"
The combination therapy may also harm patients who smoke or have
diabetes, according to Nordqvis. Thomas H. Maugh II wrote in the LA
Times that the researchers found that the drug appeared to have a modest
benefit in a subgroup of patients who had heart disease but had not had
a heart attack.
The findings are considered a significant setback for the drug's
manufacturers, Sanofi-Aventis and Bristol-Myers Squibb Co. Plavix (clopidogrel)
is the number 2 drug in the world in terms of sales, generating $6.2
billion in revenue. The drug costs about $4 per pill.
The research will appear in the April 20 issue of the New England
Journal of Medicine. In the Journal the researchers conclude that
“there was a suggestion of benefit with clopidogrel treatment in
patients with symptomatic atherothrombosis and a suggestion of harm in
patients with multiple risk factors. Overall, clopidogrel plus aspirin
was not significantly more effective than aspirin alone in reducing the
rate of myocardial infarction, stroke, or death from cardiovascular
By Dan Wilson
Books on Heart Disease
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