A U.S. Food and Drug Administration (FDA) review has determined that long-term use of the blood-thinning drug Plavix (clopidogrel) does not increase or decrease overall risk of death in patients with, or at risk for, heart disease. Our evaluation of the Dual Antiplatelet Therapy (DAPT)1 trial and several other clinical trials also does not suggest that clopidogrel increases the risk of cancer or death from cancer.
Patients should not stop taking clopidogrel or other antiplatelet medicines because doing so may result in an increased risk of heart attacks and blood clots. Talk with your health care professional if you have any questions or concerns about clopidogrel. Health care professionals should consider the benefits and risks of available antiplatelet medicines before starting treatment.
Clopidogrel is an antiplatelet medicine used to prevent blood clots in patients who have had a heart attack, stroke, or problems with the circulation in the arms and legs. It works by helping to keep the platelets in the blood from sticking together and forming clots that can occur with certain medical conditions.
Results from the DAPT trial were published in the New England Journal of Medicine in November 2014. The DAPT trial compared treatment with dual antiplatelet therapy (either clopidogrel [Plavix] or prasugrel [Effient] plus aspirin) for 12 months versus 30 months in patients who had undergone placement of a drug-eluting coronary stent. Compared to patients taking clopidogrel for 12 months, patients who were treated with clopidogrel for 30 months had lower rates of heart attacks and stent thrombosis but higher rates of death, primarily from cancer or trauma.
In order to investigate the increased risk of death and cancer-related death reported with clopidogrel in the DAPT trial, we examined the results of the DAPT trial and other large, long-term clinical trials of clopidogrel with data available on rates of death, death from cancer, or cancer reported as an adverse event.2-13
We performed meta-analyses of other long-term clinical trials to assess the effects of clopidogrel on death rates from all causes. The results indicate that long-term (12 months or longer) dual antiplatelet therapy with clopidogrel and aspirin do not appear to change the overall risk of death when compared to short-term (6 months or less) clopidogrel and aspirin, or aspirin alone. Also, there was no apparent increase in the risks of cancer-related deaths or cancer-related adverse events with long-term treatment.
The following table shows the results from the meta-analyses:
|Number of patients included||Long-term clopidogrel plus aspirin||Short term clopidogrel plus aspirin or aspirin alone|
|Overall incidence of death||56,799||6.7%||6.6%|
|Incidence of cancer adverse events||37,835||4.2%||4.0%|
|Incidence of cancer death||40,855||0.9%||1.1%|
We urge health care professionals and patients to report side effects involving clopidogrel or other antiplatelet medicines to the FDA MedWatch program
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