Kris Says:
Hi, my mother underwent an angioplasty last month and she is taking plavix and ecosprin along with other medicines. Now the doctor has suggested that we can start using clavix instead of plavix as plavix is very expensive. But I'm sceptical about it and would like to know wether Clavix is really as good as Plavix. Thanks, Kris
There are a few limitations worth mentioning. Although randomized, and comparable in size to other similar investigations, PLUTO-Diabetes was a trial with a small sample size, so chance may represent a plausible alternative explanation for these findings. A high frequency of use of concomitant medications may have affected the platelet characteristics; however, the use of most major drugs was similar between the groups. There was a 2-fold greater prevalence of using selective serotonin reuptake inhibitors in the combination group. Considering that this class of antidepressants decreases platelet activity, they may contribute to the extra antiplatelet potency seen in the aspirin and clopidogrel combination arm. In addition, the expression of multiple activation-dependent platelet receptors was studied, but their individual roles in diabetic patients are unknown. Indeed, it was expected that addition of clopidogrel to aspirin would enhance the antiplatelet potency of the regimen; however, it has not been proven to improve outcomes in a randomized trial applying various tests indicative of activation-dependent platelet characteristics. Finally, doses of aspirin >81 mg daily were not allowed and aspirin coating was not controlled and/or matched, possibly limiting the overall clinical relevance of our study. In the future, it will be important to link different glycemic profiles and vascular complications of diabetes with platelet activity and to determine how certain clinical subgroups may benefit from more aggressive antiplatelet regimens. Also critical will be to conduct longer (up to 1 year) serial assessments of platelet function to better define the durability of combination antiplatelet therapy.
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