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By Martha Kerr
ORLANDO, Mar 19 (Reuters Health) - Combining the anti-clotting drug clopidogrel with standard aspirin therapy can cut risks for death, second heart attack or stroke in patients with acute coronary syndrome by nearly 20%, according to the results of a new study. People with acute coronary syndrome have unstable angina, which is heart disease-related chest pain even at rest, and a history of mild heart attack.
Treating acute coronary syndrome with aspirin-clopidogrel could mean that "between 50,000-100,000 individuals will avoid a major adverse event (such as heart attack) in the US every year," explained study lead author Dr. Salim Yusef of McMaster University in Hamilton, Ontario. He presented the results of the study here at the annual meeting of the American College of Cardiology.
In their study, Yusef's team looked at over 12,500 patients with acute coronary syndrome. Patients received either standard anti-clotting aspirin therapy, or aspirin plus clopidogrel. Clopidogrel is currently approved for use in preventing heart attack or stroke in patients with a previous history of serious cardiovascular illness.
The investigators report that one year after initiation of therapy, just over 9% of patients receiving aspirin-clopidogrel combo therapy experienced a "major adverse event" such as heart attack or stroke, compared with 11.5% of those taking aspirin alone--a decrease of 20%.
Reductions in risk could be seen as early as 2 hours after the onset of treatment, with benefits increasing and continuing over time, the researchers note.
Yusef added that combination therapy resulted in only a "modest" increased risk of bleeding, "similar to that of aspirin." Although the risk of "major bleeds" did increase in patients taking both drugs, there was no increase in "life-threatening bleeds," according to the researchers. Patients taking clopidogrel are often warned against taking aspirin without their doctor's approval, due to the increased time it takes to stop bleeding.
Co-investigator Dr. Keith Fox of the University of Edinburgh explained that aspirin and clopidogrel appear to have a "synergistic" effect, targeting different points in the clotting process as they work together to reduce risks of heart attack and stroke.
According to the American College of Cardiology, US patients report over 1.5 million episodes of unstable angina each year.
The study was funded Sanofi-Synthelabo and the Bristol-Myers Squibb Company, who market clopidogrel under the brand names Iscover and Plavix.
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