Plavix + Aspirin = New Treatment for Atrial Fibrillation

There may be a new treatment option for atrial fibrillation patients who either cannot take the current most-often-prescribed treatment of warfarin (Coumadin) because of health concerns, or that choose not to take the drug because of the extra steps that are required and the risk of brain bleeds. There is an estimated 2.2 million Americans who suffer with atrial fibrillation, but many of them cannot be treated by Coumadin because of the high risk of internal hemorrhaging. Though aspirin has been the recommended option for patients, who can’t take Coumadin, it hasn’t proven as effective.

We may now have a new option for treating the condition with the combination of the clot-preventing drug Plavix, sold by Bristol-Myers Squibb Co. and Sanofi-Aventis SA, and aspirin. Atrial fibrillation is a condition where the upper chamber of the heart flutters and does not beat properly, preventing blood from empting completely from the hearts chambers, which can cause blood clots and increase the risk of strokes. Around 15 percent of stroke victim also suffer from atrial fibrillation. Of the 2.2 million American who suffer with the condition, 40 percent do not take Coumadin, the only treatment with the exception of aspirin, which puts patients at risk of stroke and heart attacks. The restrictions when taking Coumadin are lengthy, including blood tests every couple of weeks, modified diet, and higher risk of bleeding in the brain that coincide with taking Coumadin. Hope is on the way.

New research from a Canadian study, led by Dr. Stuart Connolly, head of cardiology at the McMaster University in Canada was recently published online by the New England Journal of Medicine, and presented at the American College of Cardiology scientific meeting. Dr. Connolly and his team studied the affects of Plavix and aspirin combined, to treat patients with atrial fibrillation, but who cannot take Coumadin. The study involved over 7,500 patients with atrial fibrillation along with one risk factor of a stroke. The patients were divided into two groups where both groups were given an aspirin daily and one group was also given 75 milligrams of Plavix daily. The combination therapy drug during the trial was referred to as ACTIVE-A.

Dr. Connolly said, “The real exciting news was stroke was reduced by 28 percent,” and ACTIVE-A resulted in major cardiovascular events such as strokes, heart attacks, and blood clots outside of the brain, being reduced by 11 percent. In previous studies, Coumadin proved success with reducing stroke risks by 32 percent when compared to the only other option previously, aspirin. The combination treatment ACTIVE-A proved successful at reducing strokes compared to aspirin taken alone, and the combination treatment actually had less side effects than Coumadin and doesn’t require the frequent checkups. However, there were 2 percent of the patients that suffered from some form of bleeding with the combination treatment and 1.27 percent with aspirin alone. Dr. Connolly said, “When we consider the risk for patients, combination therapy prevents 28 strokes, 17 of them disabling, and six myocardial infarctions [heart attacks] per 1,000 patients a year, at a cost of 20 major bleeds, three of which would be fatal.” Based on the study he said, “We can reduce major vascular events, primarily strokes, with a bearable cost in bleeding.”

We may now have a new option to ward off potential blood clots, strokes, and heart attacks with the combination treatment of Plavix and aspirin on the horizon. Dr. Connolly said in an interview, “For patients unsuitable for warfarin, this provides and important benefit at an acceptable risk. It will hopefully be incorporated into medical guidelines quite soon.”