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 .
Randomized comparison of the effects of ASA plus clopidogrel versus ASA alone on early platelet activation in acute coronary syndromes with elevated high-sensitivity C-reactive protein and soluble CD40 ligand levels.
BACKGROUND High-sensitivity C-reactive protein ( hsCRP ) and soluble cluster of differentiation 40 lig and ( sCD40L ) have been established as effective markers of inflammation in predicting the risk for adverse outcomes in patients with acute coronary syndromes ( ACSs ) . Activated platelets secrete certain inflammatory mediators such as P-selectin and sCD40L , which play a role in the pathogenesis of ACSs . Although acetylsalicylic acid ( ASA ) has been found to be an effective treatment of ACSs , the addition of clopidogrel bisulfate has been found tofurther improve clinical outcomes as a result of additional antiplatelet and anti-inflammatory action . Few data exist concerning the effects of dual antiplatelet therapy on these markers in patients with ACSs . OBJECTIVE The aim of this study was to assess the effectiveness and clinical significance of  clopidogrel  administration in patients with ACSs without ST segment elevation treated with ASA .  METHODS This r and omized , single-blind , controlled trial was conducted at the First Department of Cardiology , Hippokration Hospital , Athens , Greece . In patients aged > or=21 years with ACSs without ST segment elevation were r and omly assigned to 1 of 2 groups : ASA 325 mg/d for 1 week , followed by ASA ( 100 mg/d ) plus clopidogrel ( 300-mg loading dose followed by 100 mg/d ) for 36 weeks ( ASA+Clop group ) or ASA alone ( 325 mg/d for 1 week , followed by 75 mg/d for 36 weeks ) ( ASA group ) . Levels of serum sCD40L , hsCRP , and P-selectin were determined on admission and at 8 hours , 48 hours , and 6 days of treatment . By means of clinical follow-up , Kaplan-Meier free-of-major adverse cardiovascular events ( MACES ) plots were used to assess the prevalence of MACES , including cardiovascular-related death , in patients with and without high levels of hsCRP ( > or=3 mg/L ) and sCD40L ( > or=5 microg/L ) for 52 weeks . RESULTS A total of 86 patients were enrolled ( 71 men , 15 women ; mean [ SD ] age , 68 [ 3 ] years ; mean [ SD ] weight , 86 [ 18 ] kg ; white race , 86 [ 100 % ] ; 43 patients per group ) . Both groups had similar initial clinical characteristics and P-selectin levels . Baseline hsCRP and sCD40L levels were correlated with baseline P-selectin levels ( hsCRP , r2=0.099 CONCLUSIONS The results of this small study suggest that early activation of platelets , as measured using P-selectin levels , was effectively inhibited by the addition of clopidogrel to a regimen of ASA in the subgroup of patients with ACSs and intense activation of platelets ( defined as high hsCRP and sCD40L levels ) . In patients without high hsCRP and sCD40L levels , the addition of clopidogrel did not have a significant effect on P-selectin levels
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 .