Dual Antiplatelet Therapy for Prevention of Recurrent Ischemic Events

Jean Nappi, PharmD, Fccp, Bcps; Robert Talbert, PharmD, Fccp, Bcps

Disclosures

Am J Health Syst Pharm. 2002;59(18) 

In This Article

Ongoing Studies With Antiplatelet Therapy

Clinical trials evaluating the efficacy and safety of combination anti-platelet therapy in the prevention of recurrent ischemic events are ongoing. The Second Chinese Cardiac Study will compare one group of patients receiving clopidogrel 75 mg/ pyday plus aspirin 162 mg/day with those taking aspirin alone in the risk reduction of major vascular events, death, reinfarction, or stroke and death after an acute MI.[82] It will also evaluate the effects of metoprolol on the primary endpoints of death, reinfarction, or cardiac arrest and death. A projected 20,000-40,000 patients are to be enrolled, and completion is expected in 2003.[14,82] The Clopidogrel for Reduction of Events During Observation trial has enrolled 2000 patients undergoing PCI with or without inserting a stent.[83] The study has a dual purpose: evaluate the effect of clopidogrel with or without a loading dose at 28 days and evaluate at 12 months the efficacy and safety in the reduction of death, MI, and any revascularization or stroke. All patients will receive aspirin indefinitely.

The Management of Atherothrombosis with Clopidogrel in High-Risk Patients (MATCH) trial will assess the efficacy of clopidogrel plus aspirin versus clopidogrel alone in patients with a recent TIA or stroke who have additional risk factors (e.g., diabetes, prior atherothrombotic events) for recurrent ischemic events.[84] The European Stroke and Australian Stroke Prevention in Reversible Ischemia Trial will randomize 4500 patients with TIA or minor ischemic stroke from more than 10 countries to oral anticoagulation therapy (to an international normalized ratio [INR] of 2-3) the combination of dipyridamole (400 mg/day) plus aspirin (any dose from 30 to 325 mg/day), or aspirin alone (any dose from 30 to 325 mg/day).[86] The primary outcome measure will be the first occurrence of vascular death, nonfatal stroke, nonfatal MI, or major bleeding complication.[86] Results from these studies will provide pivotal data to address the use of dual antiplatelet therapy in the secondary prevention of ischemic vascular events.

The Warfarin Antiplatelet Therapy in Chronic Heart Failure (WATCH) study is a multicenter trial that will evaluate the efficacy and safety of anticoagulant versus anti-platelet therapy in reducing the risk of ischemic events in patients with heart failure and assess aspirin- angiotensin-converting-enzyme inhibitor interactions.[85] The study will enroll 4500 patients at 100 centers in the United States and Canada for five years. Patients will be randomized to three treatment groups: clopidogrel 75 mg/day, aspirin 160 mg/day, or warfarin to achieve an INR of 2.5-3.0.

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