Clopidogrel anticlotting prescription, in doubled dosages minimizes risk of cardiovascular deaths, heart attaches ad strokes by 14%. Intensified bleeding in patients did rise by 40%, but proved to show zero percent increase in coronary artery bypass graft surgery patients, intracranial bleeding or fatalities.
The study conducted by Dr. Shamir Mehta, Hamilton General Hospital and McMaster University, Hamilton, ON, Canada, concludes that double-dose clopidogrel regiment can be considered for all acute coronary cases. This technique is best utilized during PCI or precautionary coronary intervention.
In Mehta’s study, 8560 patients were assigned to double-dose and 8703 to single doses of clopidogrel, and 8624 to high-dose and 8639 to low-dose aspirin. Aspirin is often used in combination with clopidogrel for the best effect in patients. Aspirin has an antiplatelet effect by inhibiting the production of thromboxane, which under normal circumstances binds platelet molecules together to create a patch over damage of the walls within blood vessels. Because the platelet patch can become too large and also block blood flow, locally and downstream, aspirin is also used long-term, at low doses, to help prevent heart attacks, strokes, and blood clot formation in people at high risk for developing blood clots.
Increased doses reduced cardiovascular death, heart attack or stroke by 14% and definite stent thrombosis risk was reduced by 46%. High-dose and low-dose aspirin did not affect the outcome. Intensified bleeding was more common with double-dose than with standard-doses, but did not differ among high-dose and low-dose aspirin.
The authors of the Hamilton General Hospital and McMaster University study, explained:
In patients undergoing PCI for acute coronary syndromes, a 7-day double-dose regimen of clopidogrel was more effective than was the standard dose regimen in reduction of ischemic events and stent thrombosis. Daily high-dose aspirin did not significantly differ from low-dose aspirin. A double-dose regimen of clopidogrel can be considered for all patients with acute coronary syndromes treated with an early invasive strategy and intended PCI,
Dr Gregg Stone, Columbia University Medical Center and New York Presbyterian Hospital, NY, USA provides support by saying:
Presumably, any benefits from reduced ischemic complications in reducing mortality were offset by increased rates of major bleeding with double-dose clopidogrel. A reduction in major ischemic complications must be achieved without increasing overall bleeding, or vice versa, to further reduce mortality with antiplatelet and antithrombotic agents. The likelihood of achieving such a balance might be increased by considering individual patient’s risks for ischemia versus bleeding. Further study is needed to establish whether clinical decision making can be improved with point-of-care platelet-function testing, by assessing the genetic potential for drug metabolism, or both.
Shamir R Mehta, Jean-Francois Tanguay, John W Eikelboom, Sanjit S Jolly, Campbell D Joyner, Christopher B Granger, David P Faxon, Hans-Jurgen Rupprecht, Andrzej Budaj, Alvaro Avezum, Petr Widimsky, Philippe Gabriel Steg, Jean-Pierre Bassand, Gilles Montalescot, Carlos Macaya, Giuseppe Di Pasquale, Kari Niemela, Andrew E Ajani, Harvey D White, Susan Chrolavicius, Peggy Gao, Keith A A Fox, Salim Yusuf
The Lancet Published Online September 1, 2010. DOI:10.1016/S0140-6736(10)61088-4
Written by Sy Kraft (B.A. Bachelor of Arts – Journalism – University of California, Santa Barbara or California State University, Northridge)