Health Rounds: Clopidogrel better than aspirin for preventing heart attacks and strokes

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(This is an excerpt of the Health Rounds newsletter, where we present latest medical studies on Tuesdays and Thursdays.)

By Nancy Lapid

(Reuters) -The commonly prescribed blood thinner clopidogrel should replace aspirin as a routine pill for preventing heart attacks and strokes in people who already have at least some degree of heart disease, researchers reported at the European Society of Cardiology Congress.

Pooled data on nearly 29,000 patients with coronary artery disease who had participated in seven earlier randomized trials showed that those taking clopidogrel had a 14% lower risk of major adverse cardiovascular or cerebrovascular events, including heart attack, stroke, or cardiovascular death, compared to those taking aspirin, during an average follow-up of 5.5 years.

“These results suggest that clopidogrel should be considered the preferred long-term antiplatelet medication for patients with established coronary artery disease,” the researchers said.

Clopidogrel is the generic name of the widely used blood clot preventer Plavix, sold by Bristol Myers Squibb and Sanofi. Several companies sell generic clopidogrel including Aurobindo Pharma, Sun Pharma and Teva Pharmaceuticals.

Rates of anticoagulant-related side effects like ulcers and major bleeding were similar between the two drugs, dispelling concerns that clopidogrel might lead to more bleeding complications, the researchers said.

The researchers said their analysis included many types of patients and subgroups to ensure the findings, which were also published in The Lancet, applied broadly.

“Even patients who might respond less well to clopidogrel due to genetic or clinical factors still benefited from its use over aspirin,” the researchers said in a statement.

Because clopidogrel is widely available and inexpensive, the study’s findings have the potential to influence clinical guidelines worldwide and improve patient outcomes, the researchers said.

RECYCLED PACEMAKERS IMPROVE ACCESS IN LOW-INCOME NATIONS

Cardiac pacemaker devices can be reconditioned to provide new hope for patients in low- and middle-income countries, researchers said at the ESC meeting in Madrid.

In Kenya, Mexico, Mozambique, Nigeria, Paraguay, Sierra Leone and Venezuela, 306 patients with a life expectancy of at least two years, a clear medical need for pacemaker therapy and no financial means to acquire one were randomly assigned to receive a reconditioned pacemaker or a new pacemaker.

The researchers’ primary concern was that reconditioned devices, which had been removed from other patients, might transmit infections when re-implanted.

A year after the pacemakers were implanted, the incidence of procedure-related infections was 1.6% for those in the reconditioned pacemaker group and 3.1% for those who got new devices. The results demonstrate that the older devices were non-inferior to new ones, the researchers said in a statement.

There were no device malfunctions in either group.

The study was conducted by doctors at the University of Michigan-based Project My Heart Your Heart, which collects pacemakers removed from cadavers by funeral directors.

“Patients in many low- and middle-income countries still have very limited access to cardiac pacing despite its routine use in higher-income countries,” study leader Dr. Thomas Crawford from the University of Michigan said in a statement.

“Indeed, access to pacemaker implantation is around 200-fold lower in Africa than in Europe,” Crawford said.

Project My Heart Your Heart developed a comprehensive protocol for cleaning, functional testing and sterilizing reconditioned devices, and has U.S. approval for their export to countries whose governments have provided permission for pacemaker importation, he added.

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(Reporting by Nancy Lapid; Editing by Bill Berkrot)