If I was a cardiologist or a primary care physician or a neurologist I might love Plavix. As a neurosurgery resident I have a decidedly different view.
We know that anticoagulation therapy is associated with larger intracranial bleeds in trauma as well as worse outcomes. And we should have no doubt that antiplatelet therapy carries a similar risk. Indeed, Plavix is probably associated with worse outcomes in traumatic brain injury, although the data is scarcer for a drug like Plavix as compared to say warfarin.
Don’t get me wrong, cerebrally I know that the data supports its use whole heartedly. These are, typically, patients whom Plavix has helped save from further heart or brain attacks. The risk they face from such far outweighs the risk of an intracranial bleed. That said, it is hard to put aside what I see everyday; that is trauma patients with large bleeds associated with antiplatelet or anticoagulant use.
Well, Plavix, one of my largest scourges, is coming off patent.
The drug is set to lose its patent protection on Thursday. Faced with an expected influx of cheaper generic alternatives, Bristol-Myers Squibb, which sells Plavix in the United States under a partnership with Sanofi-Aventis, has said it no longer plans to actively promote the drug.
“This is one of the behemoth drugs that really defined the drug industry in the ’90s,” said Catherine J. Arnold, an analyst for Credit Suisse.
I’ll take comfort in the fact that the cheaper costs of generics typically does not actually lead to increased use of a drug. For me that would be a horror scenario. And I’ll keep telling myself that, despite my very limited view point, these are drugs that actually do far more good than harm.