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 .
Long-term versus short-term clopidogrel therapy in patients undergoing coronary stenting (from the Randomized Argentine Clopidogrel Stent [RACS] trial).
The optimal duration of treatment with clopidogrel after percutaneous coronary intervention ( PCI ) with stent placement remains controversial . The R and omized Argentine Clopidogrel Stent ( RACS ) trial was a prospect i ve , r and omized , nonblinded study of 1,004 patients undergoing PCI who were r and omized after successful bare metal stent placement to 30 versus 180 days of clopidogrel ; all patients also received aspirin . Patients were eligible regardless of whether they had presented with ST-elevation myocardial infa rct ion ( MI ) , acute coronary syndrome , or stable angina . The primary end point was a composite of death , MI , and stroke at 180 days . Baseline clinical characteristics showed no differences between groups in terms of age , gender , history , risk factors , or incidence of diabetes ; 72 % presented with an acute coronary syndrome and 15 % had MI as the indication for PCI . At hospital discharge and 30 days , when the 2 groups received the same treatment , there were no significant differences between groups in frequency of death , MI , or stroke . However , from 30 days to 6 months , patients assigned to 6 months of clopidogrel reached the primary end point of death , MI , and stroke less frequently ( 4.99 % vs 1.74 % , p = 0.010 , relative risk decrease 65 % ) . No significant between-group differences were found in frequency of total bleeding ( 0.64 % vs 1.52 % , p = 0.34 ) for the control and study groups . In conclusion , after successful placement of a bare metal stent in a coronary artery , patients treated with 6 months of clopidogrel showed a trend toward fewer adverse events compared with those treated for 30 days
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 .