Early clopidogrel prevents deaths
Early clopidogrel (Plavix) therapy could prevent 5,000 deaths if given to one million of the 10 million patients who have a heart attack each year, researchers argue in The
Lancet last week (2005; 266:1607).
Presenting the published results of the COMMIT
study (clopidogrel and
metoprolol in myocardial infarction trial; PJ, 19 March, p327), they
add that, although the absolute benefits of adding a few weeks of clopidogrel
to aspirin are modest, it has definite benefits and no significant hazards. “Given
the short treatment duration and fairly low cost, it could be used widely
not only in developed countries but also in many populations with more
limited resources,” they say.
The study allocated 45,852 patients admitted within 24 hours of suspected
acute MI to receive, in addition to 162mg aspirin, either placebo or
75mg of clopidogrel. Compared with placebo, allocation to clopidogrel
produced a 7 per cent proportional reduction in the number of deaths
(1,726 versus 1,845; P=0.03) and a 9 per cent proportional reduction
in the number of deaths, reinfarctions or strokes (2,121 versus 2,310;
P=0.002).
These effects were consistent across a range of patients and independent
of other treatments being used and seemed to emerge rapidly: a 12 per
cent reduction in the numbers of deaths, reinfarctions or strokes occurred
within the first 24 hours after initiation of treatment. However, treatment
with clopidogrel was associated with an increase in the number of minor
bleeds reported, although it was not associated with an excess risk of
transfused, fatal or cerebral bleeds. |
The
Pharmaceutical Journal
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