Clopidogrel is better at preventing heart attacks and strokes than aspirin, according to a new study in The Lancet.
Initially designed as an anti-inflammatory and anti-pyretic (fever-reducing) drug, once aspirin’s effectiveness for preventing blood clots was discovered in the 80’s, this over-the-counter medication rapidly increased in popularity and price, becoming the leading medicine for heart attack prevention.
Meanwhile, clopidogrel has also been used to prevent blood clots since the 90’s, but as a prescription-only product. It’s commonly given to those at risk of a heart attack and stroke, but has always been considered less effective - and thus been less popular - than aspirin.
This week, a presentation at the European Society of Cardiology congress in Madrid put paid to that idea. A study was conducted on over 28,000 subjects with coronary artery disease (CAD) and found 14% fewer major adverse cardiovascular or cerebrovascular (MACCE) events when using clopidogrel over aspirin. Better yet, concerns around a greater bleeding risk when using clopidogrel were not substantiated by the peer-reviewed study, rendering the drug safe as well as more effective.
The authors state, “These findings add to the evidence that clopidogrel monotherapy is superior to aspirin monotherapy for MACCE prevention with no increase in the risk of bleeding, and support the preferential use of clopidogrel over aspirin for secondary prevention in patients with established CAD.”
It’s often recommended for patients to take clopidogrel in conjunction with aspirin, so a further study evaluating the effectiveness of both together seems like a logical step forward to find the ultimate treatment for reducing heart attack and stroke risk.
Nevertheless, these seismic findings challenge a global doctrine on aspirin, and may open the door to investigations into which other existing medications may be most effective in other disease states.
Like aspirin, it is relatively common for a drug to see a new lease of life. This is known as drug repurposing, and was explored thoroughly during the Covid-19 outbreak. Many stages of drug-making - like safety testing - can be skipped for a pre-existing drug. This makes it a much more appealing way to manage a disease over developing a new drug from scratch.
A prime example of this in recent years is ozempic, now used by millions as a weight loss medication. Initially designed as a medication for type 2 diabetes, it propelled pharmaceutical company Novo Nordisk to the most valuable European company in the stock market in 2023, and again in June of this year.
Another example is the hair loss treatment minoxidil. “This is a medication actually for blood pressure, which vasodilates the vessels. And they found that in their studies on blood pressure, people were getting hair growth,” explained dermatologist Justine Hextall on our hair loss podcast in late August.
AI technology is also helping to utilise drug repurposing, as it can scrape large databases on many different pharmaceuticals from the past and present to see if they are potentially viable in other areas.
While clinical guidelines on heart attack medication are being re-evaluated, perhaps scientists should look to more old pharmaceuticals in the hopes of finding more old drugs with the potential for new tricks.
