The available evidence demonstrates that the use of clopidogrel plus aspirin in people at high risk of cardiovascular disease and people with established cardiovascular disease without a coronary stent is associated with a reduction in the risk of myocardial infa rct ion and ischaemic stroke , and an increased risk of major and minor bleeding compared with aspirin alone .
According to GRADE criteria , the quality of evidence was moderate for all outcomes except all-cause mortality ( low quality evidence ) and adverse events ( very low quality evidence )
BACKGROUND Aspirin is the prophylactic antiplatelet drug of choice for people with cardiovascular disease .
Adding a second antiplatelet drug to aspirin may produce additional benefit for people at high risk and people with established cardiovascular disease .
This is an up date to a previously published review from 2011 .
OBJECTIVES To review the benefit and harm of adding clopidogrel to aspirin therapy for preventing cardiovascular events in people who have coronary disease , ischaemic cerebrovascular disease , peripheral arterial disease , or were at high risk of atherothrombotic disease , but did not have a coronary stent .
Duration of dual antiplatelet therapy after implantation of drug-eluting stents.
BACKGROUND The potential benefits and risks of the use of dual antiplatelet therapy beyond a 12-month period in patients receiving drug-eluting stents have not been clearly established . METHODS In two trials , we r and omly assigned a total of 2701 patients who had received drug-eluting stents and had been free of major adverse cardiac or cerebrovascular events and major bleeding for a period of at least 12 months to receive clopidogrel plus aspirin or aspirin alone .  The primary end point was a composite of myocardial infa rct ion or death from cardiac causes . Data from the two trials were merged for analysis . RESULTS The median duration of follow-up was 19.2 months . The cumulative risk of the primary outcome at 2 years was 1.8 % with dual antiplatelet therapy , as compared with 1.2 % with aspirin monotherapy ( hazard ratio , 1.65 ; 95 % confidence interval [ CI ] , 0.80 to 3.36 ; P=0.17 ) . The individual risks of myocardial infa rct ion , stroke , stent thrombosis , need for repeat revascularization , major bleeding , and death from any cause did not differ significantly between the two groups . However , in the dual-therapy group as compared with the aspirin-alone group , there was a nonsignificant increase in the composite risk of myocardial infa rct ion , stroke , or death from any cause ( hazard ratio , 1.73 ; 95 % CI , 0.99 to 3.00 ; P=0.051 ) and in the composite risk of myocardial infa rct ion , stroke , or death from cardiac causes ( hazard ratio , 1.84 ; 95 % CI , 0.99 to 3.45 ; P=0.06 ) . CONCLUSIONS The use of dual antiplatelet therapy for a period longer than 12 months in patients who had received drug-eluting stents was not significantly more effective than aspirin monotherapy in reducing the rate of myocardial infa rct ion or death from cardiac causes . These findings should be confirmed or refuted through larger , r and omized clinical trials with longer-term follow-up . ( Clinical Trials.gov numbers , NCT00484926 and NCT00590174 .
The available evidence demonstrates that the use of clopidogrel plus aspirin in people at high risk of cardiovascular disease and people with established cardiovascular disease without a coronary stent is associated with a reduction in the risk of myocardial infa rct ion and ischaemic stroke , and an increased risk of major and minor bleeding compared with aspirin alone .
According to GRADE criteria , the quality of evidence was moderate for all outcomes except all-cause mortality ( low quality evidence ) and adverse events ( very low quality evidence )
BACKGROUND Aspirin is the prophylactic antiplatelet drug of choice for people with cardiovascular disease .
Adding a second antiplatelet drug to aspirin may produce additional benefit for people at high risk and people with established cardiovascular disease .
This is an up date to a previously published review from 2011 .
OBJECTIVES To review the benefit and harm of adding clopidogrel to aspirin therapy for preventing cardiovascular events in people who have coronary disease , ischaemic cerebrovascular disease , peripheral arterial disease , or were at high risk of atherothrombotic disease , but did not have a coronary stent .