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HWN Suggests

Drug to prevent heart attacks is not ‘better than aspirin’ for everyone

Clopidogrel is a prodrug. To work, it needs to be metabolised by a liver enzyme that varies in the population because of variations in the CYP2C19 gene. Most individuals have “normal” or “supra-normal” levels of the enzyme and clopidogrel works as expected. However, “intermediate metabolisers” activate clopidogrel less efficiently and “poor metabolisers” struggle to activate clopidogrel at all. For these people, clopidogrel may not provide enough protection against heart attacks or strokes.

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 FDA Warns Plavix May Be Ineffective In Some People

The Food and Drug Administration slapped its strongest warning on Plavix, a popular pill to prevent blood clots in people with heart disease. Plavix is most likely to be ineffective in Asians. (AP Photo/Mark Lennihan) Mark Lennihan/AP The problem: the drug may not work in some people. To be effective, the medicine inside each Plavix pill first has to be activated by the liver. Turns out the enzyme that does the job isn't up to the task in some people, depending on the variation of a gene they carry. Research in the past few years has show that's problem is present in about 2 percent of Whites, 4 percent of Blacks, and 14 percent of Chinese.

Articles of Interest

A new anti‑platelet drug shows potential for treating blood vessel clots in heart attacks, strokes and, possibly, COVID‑19

Current anti-platelet medications, such as Plavix, prevent blood clotting that cause heart attack and stroke but also disrupt platelets’ ability to stop bleeding if a blood vessel becomes leaky. The current drugs have only mild effects in preventing inflammation.

Beware of Plavix: Your Next On-Call Nightmare

Clopidogrel, a life-saving antiplatelet drug prescribed for a widening variety of cardiovascular indications, is associated with increased risk for GI bleeding – one of our most common on-call calls. To reduce the incidence of clopidogrel-induced bleeding, PPIs such as omeprazole (Prilosec) are often prescribed, since these agents reduce the prevalence of ulcers and erosions, which tend to bleed more in patients taking clopidogrel. Why the concern about PPIs? Well emerging data show that although omeprazole protects patients against clopidogrel’s adverse GI effects, it might also negate clopidogrel’s cardiac protection. I

Brilinta trumps Plavix in antiplatelet effect in ACS patients

Compared with clopidogrel, ticagrelor achieves better antiplatelet effect in the first hours of treatment and in maintenance therapy for patients with acute coronary syndromes (ACS), according to the substudy PLATO PLATELET published online Sept. 9 in the Journal of the American College of Cardiology.

Doctors find drug that is better than aspirin at preventing heart attacks

For decades, millions of people have been advised to take aspirin to reduce their risk of experiencing a serious cardiovascular event. A daily low-dose aspirin makes blood less sticky and helps prevent heart attacks and strokes. But now a new study, presented at the world’s largest heart conference, has found that clopidogrel, a commonly prescribed blood thinner, is more effective – and with no extra risk.

Plavix vs. Aspirin

In a study focusing on the combination of Plavix and aspirin, the section of the study was terminated and patients were told to stop taking Plavix and take aspirin only, as they found evidence that the Plavix-aspirin combination significantly increased the risk of death. The combination of drugs also increases the risk of gastrointestinal bleeding, and more than doubles fatal hemorrhaging. Taking aspirin, rather than Plavix, can also save you money. Aspirin will cost you about $6/month, while Plavix will break the bank with around $200/month spent on the drug (the generic clopidogrel costs less.) It is hard to find a justification for a drug that not only increases your risks of death, but costs you money.

Questions Are Raised About the Safety of a Major Heart Drug

Cardiologists are re-evaluating how they prescribe Plavix, a popular heart medication, after a major clinical study found the drug may cause dangerous bleeding in patients who take it along with aspirin to ward off a first heart attack. Plavix, which helps prevent blood clots, is one of the world's top-selling drugs.

Study Raises Questions on Plavix Safety

Patients taking Plavix, a popular and expensive antistroke drug, experience more than 12 times as many ulcers as patients who take aspirin plus a heartburn pill, a study to be published today in The New England Journal of Medicine found. Up to half of those now taking Plavix do so because their doctors assume that Plavix is safer on the stomach than aspirin, said Dr. Francis K.L. Chan, the study's lead author. Both the American College of Cardiology and the American Heart Association recommend that heart and stroke patients at risk of developing ulcers be given Plavix instead of aspirin.

The Great Plavix Disaster

I've been remiss in not covering the Plavix situation, which is quite a story. The huge-selling anticoagulant is marketed in the US by Bristol-Meyers Squibb and in the rest of the world by Sanofi-Aventis. It's been the target of the Canadian generic firm Apotex, who've maintained that key parts of its patent coverage are invalid. They won the right from the FDA back in January to sell their generic form - but keep in mind that the FDA is not concerned with patent law, only the drug's manufacturing standards and identity with the original version.

Ticagrelor versus clopidogrel in the management of acute myocardial infarction

Evidence from randomized clinical trials demonstrates that ticagrelor reduces infarct size, prevents remodeling, and reduces mortality rate after acute myocardial infarction to a greater extent than clopidogrel. However, some angiography studies show no difference between the two treatment regimes

What Your Doctor May Not Be Telling You About Plavix

Plavix prevents blood from clotting. Blood clotting happens when platelets—cell fragments in the blood—group together. If your blood has too few platelets, it won’t clot and you might not stop bleeding. Too many platelets can cause large blood clots that may block veins or arteries, or even cause a heart attack or stroke. Plavix is absorbed and activated in the liver and prevents platelets from grouping together. For most patients, Plavix prevents clots from forming, but for some people, Plavix doesn’t work. A genetic difference in a small number of people, about two to fourteen percent of the US population, prevents their bodies from metabolizing Plavix as they don’t produce enough of the compound that causes the liver to metabolize it. For people with this genetic condition, Plavix may not prevent a heart attack or stroke. Your doctor can do testing to find out if you are one of the group of people for whom Plavix will not work.