DRUG COMBO COULD HARM PATIENTS WITHOUT CLINICALLY EVIDENT CVD
A recent study of the safety and efficacyof clopidogrel (Plavix; 75 mg perday) plus aspirin (75-162 mg per day),compared with aspirin alone, resulted infindings that suggested no benefits andpossible harm from the combination ofthe 2 drugs. The study included 15,603patients with either clinically evidentcardiovascular disease (CVD) or multiplerisk factors for CVD. After a median of 28months of follow-up, the primary efficacyend point—a composite of myocardialinfarction (MI), stroke, or death fromcardiovascular causes—occurred inpatients with established CVD at ratesof 6.8% in the clopidogrel group and7.3% in the placebo group. In patientswith risk factors but no evidence of CVD,events occurred at rates of 6.6% in theclopidogrel group versus 5.5% in theplacebo group. Although this findingwas not statistically significant, therates of death between the 2 groupsdid reach statistically significant levels.Severe bleeding risks were elevatedin the combination group (1.7%vs 1.3%), as were the risks of moderatebleeding (2.1% vs 1.3%).
The American Heart Association hasissued a statement specifying thosepatients that may benefit from the useof clopidogrel. They include somepatients who have had an MI; patientswho have had angioplasty for unstableangina or heart attack; patients whohave received either a bare-metal ordrug-eluting stent; patients with peripheralartery disease; and patients whohave had a transient ischemic attack orother stroke.
Dr. Garrett is a clinical pharmacist practitionerat Cornerstone Health Care in HighPoint, NC.