Submitted by admin on Fri, 2005-11-04 09:01. ::
WASHINGTON, Nov. 3 (UPI) -- A British study released Thursday indicates combining the anti-clotting drug clopidogrel with aspirin to treat heart attacks could prevent thousands of deaths, recurrent heart attacks and strokes each year.
The study shows that clopidogrel -- sold by Bristol-Myers Squibb under the trade name Plavix -- provides a benefit to heart-attack patients with an elevated ST-segment reading on an electrocardiogram.
The study, known as the Clopidogrel and Metoprolol in Myocardial Infarction Trial, or COMMIT, also suggested beta-blockers could offer the most beneficial treatment of heart attacks if they are administered after the patient has stabilized.
In the clopidogrel arm of the trial, the researchers found combining the drug with aspirin reduced deaths, recurrent heart attacks and strokes by 9 percent compared with placebo.
"Clopidogrel (probably starting with a loading dose) should be considered for almost all patients presenting in hospital with suspected acute (heart attack), irrespective of their age, sex and the use of other treatments (provided there are no strong contraindications)," Zhengming Chen, of the University of Oxford, and colleagues write in the Nov. 5 issue of The Lancet.
Approximately 10 million heart attacks occur worldwide each year. The addition of clopidogrel to the treatment of just 1 million of those patients could prevent 5,000 deaths and 5,000 recurrent heart attacks and strokes, Chen's team estimated.
Continuing clopidogrel after the patients are discharged could increase those numbers, the researchers said, but they cautioned that the strategy's benefits and hazards still are being investigated.
In addition, Chen's team said because clopidogrel does not require close monitoring and is relatively inexpensive, it could be used for treatment of heart attack in developing countries, where heart disease is on the rise.
In the study, nearly 23,000 patients admitted to hospital within 24 hours of a suspected heart attack were given 75 mg of clopidogrel together with 162 mg of aspirin daily for about two weeks. About 93 percent showed an elevated ST-segment.
Approximately 10 percent of those who received placebo died or suffered a stroke or recurrent heart attack, compared with 9 percent of the clopidogrel group.
Clopidogrel also appeared safe, Chen's team said, noting there was no excess risk of bleeding overall or in patients over age 70 or who had been given a class of drugs called fibrinolytics.
In an accompanying comment, Marc Sabatine, of the cardiovascular division of Brigham and Women's Hospital and Harvard Medical School, said, "The addition of clopidogrel to aspirin represents a major advance in the care of patients with acute (heart attack), with clear benefit across a broad range of patient demographics and practice patterns."
In the beta-blocker arm of the trial, nearly 23,000 patients hospitalized within 24 hours of a suspected heart attack initially were given up to 15 mg of metoprolol intravenously, followed by 200 mg orally each day, until they were discharged or up to four weeks.
The metoprolol group experienced five fewer recurrent heart attacks and ventricular fibrillations per 1,000 treated compared with those who had received placebo. The metoprolol group, however, also experienced 11 more patients developing cardiogenic shock -- or the inability of the heart to pump an adequate amount of blood -- per 1,000 than the placebo group.
"The use of early beta-blocker therapy in acute (heart attack) reduces the risks of reinfarction and ventricular fibrillation, but increases the risk of cardiogenic shock, especially during the first day or so after admission," Chen's team stated. "Consequently, it might generally be prudent to consider starting beta-blocker therapy in hospital only when the (patient) has stabilized."
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