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'Superaspirin' dose may save lives

Giving drug before instead of during angioplasty may halve certain risks

STOCKHOLM, Sweden — Giving heart attack patients a dose of "superaspirin" before rather than during a procedure to restore blood flow to the heart could save tens of thousands of lives a year, new research suggests.

In a major international study presented Sunday at a meeting of the European Society of Cardiology, scientists found that giving heart attack victims the drug Plavix when they arrive at the emergency room almost halved the risk of a stroke, a repeated heart attack or death within the first month after angioplasty.

Angioplasty, a procedure where doctors thread a needle through the blood vessels and implant a tiny flexible mesh tube to prop open narrowed or clogged arteries, is performed on about 2 million people worldwide every year.

Patients during this procedure are routinely given Plavix, often called superaspirin because it prevents blood clots in a similar way to aspirin but has a higher potency, because inflating the mesh tube inside the blood vessels disturbs the lining of the artery and attracts clots.

However, in the study of 1,863 heart attack patients, led by Dr. Marc Sabatine from the Harvard University-affiliated Brigham & Women's Hospital in Boston, 6.3 percent of the people who got 300 milligrams of Plavix at the time of their angioplasty had a heart attack or stroke or died from heart complications during the subsequent month. However, only 3.6 percent of those who got the drug several hours beforehand went on to suffer those problems.

"For patients, this implies that when they come in and you anticipate they will be eligible for angioplasty, it makes sense to start treatment with (Plavix) as soon as possible to maximize the benefit both while you are waiting for that (angioplasty) and after," said Sabatine, who presented the findings at the conference.

The findings indicate that the strategy would save one in every 23 patients from a heart attack, stroke or heart-related death, Sabatine said.

Dr. Sidney Smith, the cardiology chief at the University of North Carolina at Chapel Hill, who was not connected with the research, said the study's findings were very important.

"You know that if you pretreat you are going to get better results," said Smith, a spokesman for the American Heart Association.

The strategy does have a downside for a small minority of patients, he said.

Some patients who doctors initially think should get angioplasty actually end up having to get coronary bypass surgery. The scenario is very rare, but if they have already been given Plavix before doctors discover they need surgery, the patients would have to wait five to seven days before the drug leaves their system because it increases the risk of bleeding during surgery.

"What we need to know is, can a dose of 600 milligrams at the time of angioplasty provide the same benefit as 300 milligrams given beforehand?" Smith said. "If you can do that, you are in a better position clinically."

However, there is also a chance that giving a higher dose would increase the risk of bleeding.

The study, funded by the U.S. National Institutes of Health, was also published Sunday in the Journal of the American Medical Association.