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 .
Six-Month Versus 12-Month Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stents: The Efficacy of Xience/Promus Versus Cypher to Reduce Late Loss After Stenting (EXCELLENT) Randomized, Multicenter Study
Background — The optimal duration of dual antiplatelet therapy ( DAPT ) after implantation of drug-eluting coronary stents remains undetermined . We aim ed to test whether 6-month DAPT would be noninferior to 12-month DAPT after implantation of drug-eluting stents . Methods and Results — We r and omly assigned 1443 patients undergoing implantation of drug-eluting stents  to receive 6- or 12-month DAPT ( in a 1:1 ratio ) . The primary end point was a target vessel failure , defined as the composite of cardiac death , myocardial infa rct ion , or ischemia-driven target vessel revascularization at 12 months . Rates of target vessel failure at 12 months were 4.8 % in the 6-month DAPT group and 4.3 % in the 12-month DAPT group ( the upper limit of 1-sided 95 % confidence interval , 2.4 % ; P=0.001 for noninferiority with a predefined noninferiority margin of 4.0 % ) . Although stent thrombosis tended to occur more frequently in the 6-month DAPT group than in the 12-month group ( 0.9 % versus 0.1 % ; hazard ratio , 6.02 ; 95 % confidence interval , 0.72–49.96 ; P=0.10 ) , the risk of death or myocardial infa rct ion did not differ in the 2 groups ( 2.4 % versus 1.9 % ; hazard ratio , 1.21 ; 95 % confidence interval , 0.60–2.47 ; P=0.58 ) . In the prespecified subgroup analysis , target vessel failure occurred more frequently in the 6-month DAPT group than in the 12-month group ( hazard ratio , 3.16 ; 95 % confidence interval , 1.42–7.03 ; P=0.005 ) among diabetic patients . Conclusions — Six-month DAPT did not increase the risk of target vessel failure at 12 months after implantation of drug-eluting stents compared with 12-month DAPT . However , the noninferiority margin was wide , and the study was underpowered for death or myocardial infa rct ion . Our results need to be confirmed in larger trials . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00698607
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 .