The Pharmaceutical Journal
Vol 269 No 7225 p736
23 November 2002

This article
Reprint
Photocopy

News summary

Clopidogrel of benefit in coronary intervention

Patients undergoing percutaneous coronary intervention (PCI) benefit from long-term treatment with clopidogrel (Plavix), researchers report. In addition, pretreatment with the drug can increase the beneficial effects if given early enough before PCI.

Dr Steven Steinhubl, University of North Carolina, Chapel Hill, speaking at this year's American Heart Association scientific sessions in Chicago, said that compared with two to four weeks of clopidogrel, clopidogrel therapy that is continued for one year after PCI is associated with a reduction in the incidence of ischaemic events.

He explained that 2,116 patients were randomised to receive a 300mg loading dose of clopidogrel or placebo three to 24 hours before PCI. All patients received daily clopidogrel 75mg and aspirin at the time of the procedure and for 28 days after that. After this four-week period, patients who had not received a loading dose of clopidogrel were switched back to placebo. Those who had been given clopidogrel continued to receive the drug. All patients were treated with aspirin for the duration of the study.

The researchers found that for patients on long-term clopidogrel treatment, the combined risk of death, myocardial infarction or stroke was reduced by 27 per cent (95 per cent confidence interval 3.9–44.4, P=0.023). "There was a 3 per cent absolute reduction in risk from 11.5 per cent to 8.5 per cent and importantly the benefit was similar in all sub-groups studied," Dr Steinhubl said. He added that the degree of benefit was similar for individual components of the combined endpoint.

There was an increase in the incidence of major bleeds in patients randomised to long-term clopidogrel, although nearly all were associated with an invasive procedure.

"If the results from this trial were applied to the 1.5 million people expected to undergo a PCI this year, over 50,000 patients who would otherwise have suffered a heart attack or stroke, or died, would not," Dr Steinhubl concluded.