The addition of Sanofi-Aventis and Bristol-Myers Squibb’s antipletelet drug Plavix (clopidogrel) to standard therapy using aspirin reduces the risk of death among patients suffering a heart attack, according to a study in The Lancet (November 5).

The mega trial, called COMMIT, involved 45,852 patients at more than 1,200 clinics in China and showed that a 75mg daily dose of clopidogrel improved on the already demonstrated benefits of aspirin therapy in heart attack patients. Adding the antiplatelet drug to aspirin led to a 9% reduction in death, a second heart attack or stroke compared to aspirin alone.

“Clopidogrel … safely reduces mortality and major vascular events in hospital, and should be considered routinely,” said the authors of the study, led by Chen Zhengming of the University of Oxford in the UK. They also noted that the benefits are achieved with a simple dosing regimen which is not too costly.

Additional studies should also be done to see if there is a benefit in continuing clopidogrel when patients leave the hospital after a heart attack, suggested the authors. One trial, CURE, has already found a benefit in this setting [[24/09/02f]].

If early clopidogrel therapy was given in hospital to just 1 million of the 10 million patients who have a heart attack every year then it would, on the evidence of the COMMIT and earlier CLARITY studies, prevent about 5,000 deaths and 5,000 non-fatal reinfarctions and strokes, said the researchers. Moreover, there appears to be no trade-off in terms of increased major bleeding episodes, they added.