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CCC: Clopidogrel and ASA Proposed New Treatment Module for Unstable Angina By Donalee Moulton Special to DG News HALIFAX, N.S. -- October 23, 2001 -- A combination of acetylsalicylic acid (ASA) and clopidogrel is expected to become standard therapy for patients with unstable angina. For those patients with acute coronary syndrome with non-ST segment elevation, combination of clopidogrel and ASA may soon be used in upwards of 95 percent of cases, said Dr. David Fitchett, Director of the Coronary Care Unit at St. Michael’s Hospital, and Associate Professor of Medicine at the University of Toronto, in Toronto, Ontario, Canada. Using this combined drug treatment regimen may reduce the risk of major complications by up to two-thirds, noted Dr. Salim Yusuf, director of cardiology at the Hamilton Health Sciences Centre, and Professor of Medicine at McMaster University, in Hamilton, Ontario. The potency of the drug combination results from the differing actions of the two agents. Clopidogrel is believed to block adenosine diphosphate (ADP) activation mechanism that stimulates platelet production. ASA, on the other hand, blocks the thromboxane A2 mechanism. Speaking at the annual meeting of the Canadian Cardiovascular Congress here, Dr. Yusuf and his colleagues examined data from the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial. The international study involved more than 12,500 patients from nearly 500 centres in more than 25 countries. Within 24 hours of the onset of unstable angina, patients received either 300 mg of clopidogrel or a placebo. This was then followed up by 75 mg/day of clopidogrel for the experimental group. All study participants also took ASA at a dose of 75-325 mg/day. Over a one-year period, the researchers found that the combination therapy of clopidogrel and ASA resulted in a 20 percent decrease in events compared with those patients who took only ASA. As well, a 14 percent reduction in the secondary end point was also recorded. The next step is for physicians to identify high-risk patients who could benefit from an aggressive treatment regimen of clopidogrel and ASA, Dr. Fitchett said. Certain groups of patients do not respond well to such treatment, including refractory patients. Dr. Fitchett recommended a management strategy based on risk stratification. Among the risk factors to be assessed are low blood pressure with marked electrocardiographic abnormalities, breathlessness, and often-recurring episodes of pain. E-mail this page to a friend or colleague! To print, use this version