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 .
Early and Late Effects of Clopidogrel in Patients With Acute Coronary Syndromes
Background —The risk of ischemic events is high , both early and late after acute coronary syndromes ( ACS ) . We examine the benefits and risks associated with the use of adding clopidogrel to aspirin within the first 30 days and later ( 31 days to 12 months ) in 12 562 patients with ACS . Methods and Results —A total of 12 562 ACS patients were r and omized to receive clopidogrel ( 300 mg initially followed by 75 mg/d ) or placebo for 3 to 12 months . The proportion of patients experiencing cardiovascular death , myocardial infa rct ion , or strokes ( primary outcome ) at 30 days was 5.4 % in the placebo group and 4.3 % in the active group ( relative risk 0.79 , 95 % CI 0.67 to 0.92 ) . Beyond 30 days , the corresponding rates were 6.3 % versus 5.2 % ( relative risk 0.82 , 95 % CI 0.70 to 0.95 ) . There was no significant excess in life-threatening bleeds in each period ( 0.97 % versus 1.28 % , relative risk 1.32 , 95 % CI 0.95 to 1.84 for 0 to 30 days ; 0.83 % versus 0.91 % , relative risk 1.09 , 95 % CI 0.75 to 1.59 for 31 days to 12 months ) . Further subdivision of the early data indicates benefits within 24 hours with consistently lower rates of the primary outcome in combination with refractory or severe ischemia . Conclusions —Clopidogrel reduces the risk of ischemic vascular events , with the benefits emerging within 24 hours of initiation of treatment and continuing throughout the 12 months ( mean 9 months ) of the study
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 .