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Bleeding Risk With Plavix-Aspirin Regimen May Be Serious
Date:11/22/2010

By Steven Reinberg
HealthDay Reporter

MONDAY, Nov. 22 (HealthDay News) -- Risk of bleeding for patients on antiplatelet therapy with either warfarin or a combination of Plavix (clopidogrel) and aspirin is substantial, a new study finds.

Both therapies are prescribed for millions of Americans to prevent life-threatening blood clots, especially after a heart attack or stroke. But the Plavix-aspirin combination was thought to cause less bleeding than it actually does, the researchers say.

"As with all drugs, these drugs come with risks; the most serious is bleeding," said lead author Dr. Nadine Shehab, from the U.S. Centers for Disease Control and Prevention (CDC).

While the risk of bleeding from warfarin is well-known, the risks associated with dual therapy were not well understood, she noted.

"We found that the risk for hemorrhage was threefold higher for warfarin than for dual antiplatelet therapy," Shehab said. "We expected that because warfarin is prescribed much more frequently than dual antiplatelet therapy."

However, when the researchers took the number of prescriptions into account, the gap between warfarin and dual antiplatelet therapy shrank, Shehab said. "And this was worrisome," she added.

For both regimens, the number of hospital admissions because of bleeding was similar. And bleeding-related visits to emergency department visits were only 50 percent lower for those on dual antiplatelet therapy compared with warfarin, Shehab explained.

"This isn't as big a difference as we had thought," she said.

For the study, published Monday in the Archives of Internal Medicine, Shehab's team used national databases to identify emergency department visits for bleeding caused by either dual antiplatelet therapy or warfarin between 2006 and 2008.

The investigators found 384 annual emergency department visits for bleeding among patients taking dual antiplatelet therapy
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