The study of 3,602 people who underwent angioplasty found a 28 percent lower incidence of death and major coronary problems in those who received the higher dose.
While similar results have been reported in trials comparing 600-milligram to 300-milligram doses of Plavix in other groups of patients having angioplasty, this report is the first done in people with the most severe form of heart attack.
But "Plavix is a problematic drug," said Simon, who wrote an editorial accompanying the journal report, in part because some people are genetically resistant to its activity. And so, he said, "interventional cardiologists are confused right now about what is the most effective regimen."
Prasugrel has been shown to be superior to clopidogrel in one or more trials, and a study presented at the San Francisco meeting gave the advantage to ticagrelor in a head-to-head trial with clopidogrel.
"The biggest news was that ticagrelor reduced total mortality by an absolute 1 percent, which was a relative 19 percent reduction in mortality compared to clopidogrel," said Dr. Christopher Cannon, an attending cardiologist at Brigham and Women's Hospital in Boston, who presented the trial results at the meeting.
In addition, less bleeding was seen in people who had bypass surgery and were given ticagrelor rather than clopidogrel, he said.
One great advantage of ticagrelor is that its effects wear off in about 48 hours, compared to five days for clopidogrel, which reduces the possibility of unwanted bleeding, Cannon said.
Still, most people treated at Brigham and Women's Hospital get clopidogrel, with prasugrel reserved for cases in which excess bleeding is especially dangerous, he said.
The transition to the newer clot-dissolving drugs is complicated by the issue of cost, Simon said. A generic version of Plavix is now available in Europe and is expected to be avai
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