Plavix Helps Heart Attack Patients Survive

Clot-buster lowered risk of second heart attacks, strokes and death in large trial

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By Ed Edelson
HealthDay Reporter

FRIDAY, Nov. 4, 2005 (HealthDay News) -- Adding the clot-preventing drug clopidogrel to the emergency treatment of heart attacks saves lives and reduces the incidence of second heart attacks and stroke, a major study finds.

It is the latest trial to show the value of clopidogrel (Plavix) in cardiac care, said Dr. Rory Collins, a professor of medicine and epidemiology at the University of Oxford in England, and a member of the team reporting the results in the Nov. 4 issue of The Lancet.

For example, a study reported a month ago showed a 50 percent reduction in deaths and other problems in heart attack patients who got clopidogrel before, rather than during, artery-opening angioplasty.

"A study reported in March looked at the effect of clopidogrel on a different outcome, whether the artery remained open," Collins said. "What our study shows is that that translates into an increase in survival and a reduction of second heart attacks."

The study could change medical practice, he said.

"At the moment, clopidogrel is not used routinely in this setting," Collins said. "It is used for people having a stent put into an artery or who have unstable angina, but it is not used routinely in the emergency treatment of heart attack. This study argues strongly for clopidogrel to be used routinely for patients having a heart attack."

The study was done in China, partly to help that nation's doctors master the treatment of heart attack, and partly because it was possible to do a study on a large scale there, Collins said.

The study included more than 45,800 patients treated at the onset of a heart attack at 1,250 hospitals. Half the patients were given standard treatment, including aspirin, while the other half also got clopidogrel.

The death rate was 7 percent lower in the patients who got clopidogrel. The incidence of second heart attacks during the treatment period was 14 percent lower, and the overall incidence of repeat heart attacks, stroke and death was 9 percent lower.

And those results "were not associated with an increase in excess bleeding," Collins said. There have been fears that clopidogrel, which prevents cells called platelets from banding together to form blood clots, might cause dangerous bleeding.

Dr. Marc S. Sabatine, an associate physician in the cardiovascular division of Brigham and Women's Hospital in Boston, and a leader of the March study, said there has been a trend toward using clopidogrel early for a heart attack, and that the new study results should accelerate that trend.

"Our population was only 3,500 patients," Sabatine said. "This larger trial gives larger, definitive data. I suspect that, based on these results, the treatment will be adopted by physicians."

Another part of the study looked at the use of beta blocker drugs in the emergency treatment of heart attacks. It found an overall neutral effect -- a 15 percent to 20 percent decrease in second heart attacks and an abnormal heart rhythm offset by a 30 percent increase in cardiac shock in the first day or two after admission.

That result will help refine the use of beta blockers in early treatment of heart attacks, Sabatine said. Beta blockers should not be used immediately when there is low blood pressure and evidence of heart failure, but "we can wait until blood pressure and heart function stabilize a bit before we begin to use them," he said.

More information

You can learn more about clopidogrel by consulting the National Library of Medicine.

SOURCES: Rory Collins, M.D., professor, medicine and epidemiology, University of Oxford, England; Marc S. Sabatine, M.D., associate physician, cardiovascular division, Brigham and Women's Hospital, Boston; Nov. 4, 2005, The Lancet

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