The approval of a new antiplatelet drug which will eventually become a competitor with clopidogrel (Plavix) has been delayed by the Food and Drug Administration (FDA). The new drug, ticagrelor, was recently approved in Europe. The drug has received quite a bit of coverage in the lay press here in the U.S.

The FDA has asked for further evaluation of the PLATO trial which is a study conducted on 18,000 patients in 43 countries around the world to evaluate the new drug. In the 1,814 patients studied in the U.S. and Canada the outcome was worse in the patients taking ticagrelor as compared to clopidogrel (Plavix).

A spokesperson for drug company AstraZeneca says that the company remains confident that the drug will be approved. bjmdjd

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antiplatelet drug · AstraZeneca · clopidogrel · PLATO trial · Plavix · ticagrelor

I can remember not too many years ago cardiac patients usually took aspirin as a preventative medication (anti platelet med) and if you were at a high risk for problems (and you could afford it) you took clopidogrel (Plavix). Both excellent and fairly safe drugs if used as recommended. Not long ago it became fashionable to give patients both drugs for added protection. Is that a good idea?

This week a study published in the Archives of Internal Medicine states that the risk of bleeding in these patients taking both medications is substantial and should be treated as such. Even though this approach is still safer than warfarin which is also prescribed for several cardiac problems, the risk needs to be recognized. 

In this study there were 7,764 emergency room visits among the dual treated patient group and most of those were for bleeding though usually minor. There were 40,924 warfarin treated patients for bleeding which were recorded for context. Once again most of this bleeding was also minor. The bleeding risk with warfarin is rarely ignored while the risk for dual anti platelet therapy is often down played or not recognized.

While the bleeding may not usually be serious in these patients on both aspirin and clopidogrel (Plavix), the risk is real and should be taken seriously by doctors and patients alike. The authors of the study also suggest that patients should be made aware of the risk of bleeding but stress that the risk is not a reason to abandon the therapy.

If you or a loved one is on both aspirin and clopidogrel (Plavix) you may want to discuss what you might expect with your prescriber. bjmdjd

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Archives of Internal Medicine · aspirin · Plavix · risk of bleeding · warfarin

As I mentioned recently on a radio program that I record, stents are usually placed after a  balloon angioplasty procedure. It’s also important to have these patients be put on anti platelet drugs immediately. Most people refer to these anti platelet medications as blood thinners (though this is not exactly correct). The most popular one available by prescription is clopidogrel (Plavix).

Research published in the April 20, 2010 online edition of Circulation: Cardiovascular Quality and Outcomes reported that patients who had a drug eluding stent placed and delayed in filling their prescription for clopidogrel had much higher rates of death/heart attack during the follow up period.

The reasons for filling the prescriptions were varied but showed how important discharge planning is for many patients after hospitalization. Money is not always the determining factor as many patients have co-morbid conditions and transportation problems that may delay their going to the pharmacy.  bjmdjd

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Circulation Journal · clopidogrel · drug eluding stents · Plavix