Anti-platelet drug lowers heart attack, stroke risk
September 1, 1998 2 minutes read
Anti-platelet drug lowers heart attack, stroke risk
Clopidogrel: $2.40; ticlopidine: $3.16
The new drug clopidogrel may be slightly more effective and safer than aspirin in lowering the risk of repeat heart attacks and strokes. But before prescribing the platelet inhibitor, doctors must decide whether Plavix, manufactured by Bristol-Myers Squibb in Princeton, NJ, provides enough extra benefit to justify having their patients pay $2.40 for a daily 75 mg dose, substantially more than the pennies a day aspirin costs. A competitor, ticlopidine (Hoffman-Laroche's Ticlid) has a wholesale price of $3.16 per day of therapy. Plavix requires no routine bimonthly CBC monitoring because it is less likely than ticlopidine to cause side effects.
In a recent three-year study from the Texas Heart Institute at St. Luke's Episcopal Hospital in Houston dubbed CAPRIE (Clopidogrel vs. Aspirin in Patients at Risk of Ischemic Events) 19,000 patients in 16 countries were followed over three years, and clopidogrel reduced the risk of a repeat heart attack, stroke, or vascular death in patients with atherosclerosis by about one-third, while aspirin lowered the risk by about one-quarter. (See http://www.tmc.edu/thi/caprie.html on the Internet for further details.) Because of the small difference, Plavix's manufacturer is not allowed to advertise the drug as "better than" aspirin.
In contrast to aspirin but similar to ticlopidine, clopidogrel works by inactivating blood platelets so they cannot initiate the process of forming thrombi in diseased blood vessels. Its main side effects are rash and diarrhea - and patients in the study suffered slightly fewer ulcer-related side effects than aspirin users.
Karen N. Elder, RN, MSN, coordinator of case management practices at Vanderbilt University Medical Center in Nashville, TN, and consulting editor of Cost Management in Cardiac Care, says that ticlopidine is close to going generic, and it will be much cheaper soon. Her facility uses that drug typically for patients who have had a stent placed. "It's used also for patients with an aspirin allergy," she reports. "Others - for example, angiography patients with no blood clots - are given aspirin."
Kimberly Bell, RN, CCRN, nurse clinician for the coronary care unit and coronary progressive care unit at St. Francis Hospital and Health Centers in Beech Grove, IN, says that a big advantage of clopidogrel is that patients have less GI distress and fewer problems with dropping their white blood cell count and being at risk for infection than with other platelet inhibitors. "We give Plavix strictly in place of Ticlid now, and have been for the past few months." It's administered to all of St. Francis's new post-stent patients. "We still prescribe ticlopidine for patients coming back for another stent in another artery. If they've been on it, and they didn't have side effects from it, we keep them on it."
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