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 .
Combined clopidogrel–aspirin treatment for high risk TIA or minor stroke does not increase cerebral microbleeds
Abstract Objectives : To study whether Clopidogrel – Aspirin combined treatment for high risk transient ischaemic attack ( TIA ) or minor stroke results in increased number of lesions associated with anti-thrombotic cerebral haemorrhage or cerebral micro-bleeds ( CMB ) than aspirin alone treatment . Methods : The patients recruited in CHANCE test in our hospital participated in this study . We made a comparison between treatments Aspirin – Clopidogrel combined group and the Aspirin alone group in the numbers of CMB and subsequent cerebral haemorrhages . In addition , we analysed the association between the increased numbers of CMB and subsequent intracerebral haemorrhages .  All 129 patients with high risk TIA with microbleeds or minor stroke within 24 hours after the onset ( average age 65.9 ± 9.3 , 48.7 % were male patients ) were divided r and omly into two groups : ( 1 ) 67 patients were given combination therapy with clopidogrel and aspirin ( clopidogrel at an initial dose of 300 mg , then 75 mg per day for 90 days , plus aspirin at a dose of 75 mg per day for the first 21 days);(2 ) the rest patients were given aspirin treatment ( 75 mg per day for 90 days ) . All participants received open-label aspirin at a clinician-determined dose of 75–300 mg on the first day . Results : The CMB were found in 52.7 % of all patients in both groups . There was no siginificant difference between the Aspirin group and the Aspirin – clopidogrel treated group , though the latter showed some slight increase in CMB ( Odds ratios ( OR ) = 1.16 , 95 % confidence intervals ( CI ) = 0.54–2.47 , P = 0.71 ) . But the numbers of CMB were remarkably associated with the number of primary existing CMB ( OR = 6.46 , 95%CI 2.57–16.23 , P < 0.001 ) , especially that of primary existing CMB ≥ 3.In addition , the increasing numbers of CMB associated with primary CMB lesions , which located in corticosubcortical area ( CSC ) ( OR = 4.69 , 95%CI 1.51–14.53 , P = 0.007 ) . Conclusions : For the treatment of high-risk TIA or minor stroke patients , the clopidogrel – aspirin treatment did not increase the number of CMB  than Aspirin alone . It appears that the extent of CMB was associated with the extent of existing CMB occurred in previous stroke , which was mostly located in cortical , subcortical zone
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 .