New Drug Recommended for Patients Getting Heart Surgery

Aug. 16, 2001 -- More and more doctors are choosing to treat patients with blocked heart arteries -- the most common cause of heart attacks -- with procedures that do not involve heart bypass surgery. These procedures, such as balloon angioplasty and coronary stenting, are less traumatic and involve threading a thin tube through a blood vessel and opening the blockage, and at times, propping the artery open. All of these surgeries, bypass surgery as well as the less traumatic procedures, have been shown to effectively treat the blockage in the heart artery.

There is, however, a small but worrying risk of having a heart attack or a stroke after these surgeries.

A new study finds that combining aspirin -- which has already been shown to reduce the chances of a heart attack- with a newer drug called Plavix can significantly cut the risk of heart attack or stroke in these patients. These findings are important enough that the prestigious medical journal The Lancet took the unusual step of publishing them a few days early.

Early results from a study of more than 12,500 patients who used Plavix to prevent heart attacks and strokes in patients who were treated with surgery were first released at a medical meeting a few months ago. Researchers, led by Shamir Mehta, MD and Salim Yusuf, DPhil, looked at the more than 2,600 patients in that study who were treated using balloon angioplasty and coronary stenting. Both Mehta and Yusuf are professors of cardiology at McMaster University in Toronto.

Some of these patients were given Plavix and aspirin for six days before their procedure and for up to a year after the procedure, and others were given aspirin and a placebo. The researchers found that patients who took Plavix and aspirin were 30% less likely to have heart attacks or stroke.

In fact, Yusuf tells WebMD that a detailed examination of all of the patients in the study is going to be published later this week in TheNew England Journal of Medicine, and this report finds that Plavix can also help reduce the risks of heart attacks and stroke after heart bypass surgery to a similar extent.

R.H. Stables, DM, a consulting cardiologist at Royal Liverpool University in the U.K., wrote an editorial on the study in The Lancet. He writes that while it is clear that Plavix offers a benefit in the short term -- within the first 30 days after the procedure -- long-term benefit is not so clear. "This is standard treatment now," he tells WebMD. "But I think the jury is still out on continuing the drug long term."

Both Yusuf and Mehta say that Stables is only partly right in his criticism. They say that their study was not designed to see what the long-term effects are. Yusuf says that while the jury may be out on extending Plavix treatment beyond a year, he favors extending treatment for at least year.

He says that studies that found that aspirin could prevent heart attacks were "all one-year studies, but we are all fairly comfortable in extending aspirin therapy indefinitely." In his own practice he uses Plavix for a year and then assesses risks at the one-year mark. "In high-risk patients, I will continue [Plavix] beyond a year."

One big difference between Plavix and standard aspirin is cost: Plavix costs about $3 a day. Yusuf says he, too, is concerned about the cost, but he points out that $1,000 a year is less than the cost of surgery.