Adding the clot-preventing drug clopidogrel (Plavix) to the emergency treatment of the heart attack patients saves lives and reduces the incidence of second heart attacks and stroke, a major study has found.
The Study
The study included more than 45,800 patients who were treated at the onset of a heart attack at 1,250 hospitals. Half of the patients were given the standard treatment, including aspirin, while the other half received aspirin along with clopidogrel.
The death rate was 7% lower in the patients who got clopidogrel compared with those who received only aspirin. During the treatment period, the incidence of second heart attacks for the clopidogrel group was 14% lower, and the overall incidence of repeat heart attacks, stroke and death was 9% lower than for the aspirin only group.
The results also showed that clopidogrel did not increase bleeding. There have been fears that clopidogrel may cause dangerous bleeding because the drug prevents platelets from banding together to form blood clots.
Implications
'A [previous] study looked at the effect of clopidogrel on whether the artery remained open," says Dr. Rory Collins, a professor of medicine and epidemiology at the University of Oxford in England. "'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, Collins says. 'At the moment, clopidogrel is used for people having a stent put into an artery or [for those] who have unstable angina, but it is not used routinely in the emergency treatment of heart attack," he says. "This study argues strongly for clopidogrel to be used routinely for patients having a heart attack.
Dr. Marc S. Sabatine, an associate physician in the cardiovascular division of Brigham and Women's Hospital in Boston, says there has been a trend toward using clopidogrel early in the treatment of a heart attack and that these new study results should accelerate that trend.
"This larger trial gives larger, definitive data. I suspect that, based on these results, the treatment will be adopted by physicians," Sabatine says.
Previous studies have also shown the value of clopidogrel in cardiac care. One such study found a 50% reduction in complications and deaths in heart attack patients who got clopidogrel before, rather than during, artery-opening angioplasty.
