Higher Dose of Clot-Buster Is Better Before Artery Procedure

Twice as much Plavix halves the number of deaths, heart attacks, study finds

By Ed Edelson
HealthDay Reporter

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FRIDAY, May 11 (HealthDay News) -- Cardiologists should be giving more of the clot-preventing drug Plavix than is now recommended before performing the artery-opening procedure called angioplasty, a new study says.

The analysis of 10 previous studies found that giving angioplasty patients double the current recommended dose of Plavix -- 600 milligrams rather than 300 -- cut the combined risk of heart attack and cardiac death by half, according to Dr. Anthony Abbate.

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Abbate, an assistant professor of medicine at Virginia Commonwealth University, was expected to present the findings on Friday at the Society for Cardiovascular Angiography and Interventions' annual meeting, in Orlando, Fla.

The higher dose did not increase the risk of serious bleeding, a major concern with Plavix, the analysis found.

"The evidence shown by this meta-analysis is very powerful," said Dr. Gregory Dehmer, president of the society and a professor of medicine at Texas A&M College of Medicine. "Although Plavix is powerful stuff, the meta-analysis did not find an excessive amount of bleeding. So we have a lower risk of myocardial infarction [heart attack] with no significant increase in adverse side effects."

The 10 studies analyzed by Abbate and Dr. Giuseppe G. Biondi-Zoccai, an assistant professor of cardiology at the University of Turin in Italy, included 1,500 patients who had angioplasty. Most had either 300 milligrams or 600 milligrams of Plavix before the procedure.

The incidence of cardiac death or nonfatal heart attack was 50 percent lower in the following 30 days in those getting the higher dose of Plavix. Only 3.1 percent of those getting the 600-milligram dose had in-hospital heart attacks, compared to 6.4 percent of those getting the 300-milligram dose. The overall 30-day incidence of death or heart attack was 3.8 percent for the higher dose and 7.3 percent for the lower dose, according to the study.

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