Smoking status and the effects of antiplatelet drugs

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5909 (Published 01 October 2013) Cite this as: BMJ 2013;347:f5909
  1. Michael M Hirschl, associate professor of internal medicine
  1. 1Department of Internal Medicine, Landesklinikum Waldviertel Zwettl, A-3910 Zwettl, Austria
  1. michael.hirschl{at}zwettl.lknoe.at

Smokers benefit much more than non-smokers but are at increased risk of bleeding

Dual antiplatelet therapy (clopidogrel and aspirin) is a cornerstone of treatment in acute coronary syndrome.1 Recently, new antiplatelet drugs such as ticagrelor and prasugrel have been shown to be better than clopidogrel in reducing fatal and non-fatal cardiovascular events in patients with the syndrome.2 3 However, subgroup analyses of earlier trials have raised concerns that antiplatelet therapy is not as effective in non-smokers as in smokers, a phenomenon known as the “smoker’s paradox.”4

In a linked paper (doi:10.1136/bmj.f5307), Gagne and colleagues report a meta-analysis of the effect of smoking on the efficacy of antiplatelet agents, including prasugrel and ticagrelor.5 The authors concluded that the clinical benefit of clopidogrel in …

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