McMaster University

McMaster University

Faculty of
Health Sciences

Double dose of drug reduces angioplasty complications: Study

Published: September 2, 2010
Shamir Mehta
Shamir Mehta, associate professor of medicine in the Michael G. DeGroote School of Medicine

A double dose of the anti-clotting treatment clopidogrel, also known as Plavix, significantly reduces complications in heart patients undergoing angioplasty to clear blocked arteries.

Shamir R. Mehta, an associate professor of medicine of the Michael G. DeGroote School of Medicine, led a large international study that found patients undergoing angioplasty benefited from a more aggressive antiplatelet regimen in which they received a double dose of the blood thinner for about a week.

Findings are being published simultaneously in the medical journals The Lancet and the New England Journal of Medicine from the trial called CURRENT-OASIS 7 (Clopidogrel Optimal Loading Dose Usage to Reduce Recurrent EveNTs/Optimal Antiplatelet Strategy for InterventionS).

Clopidogrel and aspirin are widely used for patients with acute coronary syndromes who are undergoing angioplasty. In the study, the authors compared higher and lower doses of clopidogrel and aspirin in preventing major cardiovascular events and stent thrombosis (narrowing of the inserted stent) in patients undergoing angioplasty.

Although there was no significant difference between the two doses of clopidogrel in the overall population of patients, the authors found using a double dose of clopidogrel reduced the risk of cardiovascular death, heart attack, or stroke by 14 per cent in the target population of over 17,000 patients undergoing angioplasty compared to the conventional dose. The double dose of clopidogrel also reduced stent thrombosis by 46 per cent in the target population compared to the standard dose.

"Our findings show that a seven-day, double-dose of clopidogrel is more effective than the standard dose regimen in reduction of heart attacks and stent thrombosis in patients undergoing angioplasty," Mehta said. "Daily high-dose aspirin did not significantly differ from low-dose aspirin."

The study authors concluded that a double dose regimen of clopidogrel can be considered for all patients with acute coronary syndromes treated with an early invasive strategy and intended early angioplasty (also known as percutaneous coronary intervention, or PCI). In those patients who are unlikely to undergo angioplasty, the standard dose of clopidogrel should be used.

CURRENT-OASIS 7 is a phase three, multicentre, multinational, randomized, parallel-group trial involving 597 hospitals in 39 countries and is largest such trial ever performed in a broad range of patients with acute coronary syndromes.

The study was sponsored by Sanofi-Aventis and Bristol-Myers Squibb and conducted by the Population Health Research Institute of McMaster University and Hamilton Health Sciences.

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