Plavix-Aspirin Combo Reduces Acute Heart Attack Deaths

Giving Plavix (clopidogrel) in addition to Aspirin to patients in the throes of a suspected Heart Attack could save thousands of lives each year, researchers here and in China reported.

In a study of nearly 46,000 patients with suspected acute myocardial infarctions, there was a 9% drop in the combined rate of death, stroke, or reinfarction among patients randomized to received 75 mg of Plavix plus 162 mg of Aspirin daily, compared with those who received Aspirin alone.

So reported Zhengming Chen, M.D., of the Clinical Trial Unit at the University of Oxford, on behalf of the COMMIT (Clopidogrel and Metoprolol in Myocardial Infarction Trial) investigators.

The combined Plavix-aspirin therapy was also associated with a 7% relative reduction in all cause mortality, the investigators noted in a study published in the Nov. 5 issue of The Lancet.

"If early clopidogrel therapy was given in hospital to just one million of the 10 million patients who have a Heart Attack every year then it would, on present evidence, prevent about 5,000 deaths and 5,000 non-fatal reinfarctions and strokes," Dr. Chen and colleagues wrote. "Moreover, continued treatment with clopidogrel after hospital discharge could lead to further net gains, although the benefits and hazards of more long-term therapy are still under investigation."

In a second part of the study, also published in Lancet, the COMMIT researchers looked at the effect of giving patients with acute MI early 15mg of intravenous metoprolol then 200mg of oral metoprolol daily. They found that while the treatment could cut the relative risk of repeat Heart Attack and of ventricular fibrillation by about 15% to 20%, it increased the risk of cardiogenic shock by 30%.

The combination of the platelet inhibitor Plavix with Aspirin has been shown in other trials to reduce the risk of ischemic events, compared with Aspirin alone, in patients undergoing percutaneous coronary procedures, as well as those with non ST-segment elevation acute coronary syndromes.

In addition, results of the CLARITY trial, published earlier this year in the New England Journal of Medicine, showed that Plavix plus aspirin helped retain the patency of blocked coronary arteries following clot-busting fibrinolytic therapy, and there was evidence to suggest that the combination could reduce clinical events, the investigators noted.