Double-Dose Plavix Benefits Certain Patients, Study Finds

And higher-dose aspirin is no more effective than low dose, researchers say

By Steven Reinberg
HealthDay Reporter

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WEDNESDAY, Sept. 1 (HealthDay News) -- More isn't necessarily better when prescribing the two drugs commonly used to treat patients who are in danger of having a heart attack, Plavix (clopidogrel) and aspirin, a new study suggests.

Two reports on the data find that high doses of Plavix are good for some patients, but not all, while high-dose aspirin is no better than a low dose for preventing new heart attacks, other cardiac problems, stroke and death.

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The findings suggest a need to assess the risks and benefits individually, experts say.

Patients who are at high risk for heart attack and stroke and low risk for bleeding are going to do well on a higher dose of Plavix, said Dr. Gregg Stone, author of an editorial in The Lancet.

"Patients who are at lower risk for atherosclerotic complications, but high risk for bleeding should be treated with a more conservative lower dose," added Stone, director of cardiovascular research and education at Columbia University Medical Center in New York City.

The reports are being released Wednesday to coincide with the meeting of the European Society of Cardiology in Stockholm. They are also published in the Sept. 1 online edition of The Lancet and in the Sept. 2 issue of the New England Journal of Medicine.

While aspirin and Plavix are mainstays of treatment for those at risk of having a heart attack, questions remain about proper dosing. Too little medicine won't prevent clotting, which can lead to heart attack, while too much can cause fatal bleeding.

To assess the best treatment regimens, the researchers assigned 25,086 patients at risk of having a heart attack (due to acute coronary syndrome) to a standard dose or double dose of Plavix and to high- or low-dose aspirin. Patients on the standard dose of Plavix got 300 milligrams (mg) the first day followed by 75 mg daily, while those with the double dose took 600 mg on day one, followed by 150 mg for six days and 75 mg thereafter. Patient outcome was evaluated after 30 days.

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