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 .
Short- Versus Long-Term Duration of Dual-Antiplatelet Therapy After Coronary Stenting: A Randomized Multicenter Trial
Background — The optimal duration of dual-antiplatelet therapy and the risk-benefit ratio for long-term dual-antiplatelet therapy after coronary stenting remain poorly defined . We evaluated the impact of up to 6 versus 24 months of dual-antiplatelet therapy in a broad all-comers patient population receiving a balanced proportion of Food and Drug Administration – approved drug-eluting or bare-metal stents . Methods and Results — We r and omly assigned 2013 patients to receive bare-metal , zotarolimus-eluting , paclitaxel-eluting , or everolimus-eluting stent implantation . At 30 days , patients in each stent group were r and omly allocated to receive up to 6 or 24 months of clopidogrel therapy in addition to aspirin . The primary end point was a composite of death of any cause , myocardial infa rct ion , or cerebrovascular accident . The cumulative risk of the primary outcome at 2 years was 10.1 % with 24-month dual-antiplatelet therapy compared with 10.0 % with 6-month dual-antiplatelet therapy ( hazard ratio , 0.98 ; 95 % confidence interval , 0.74–1.29 ; P=0.91 ) . The individual risks of death , myocardial infa rct ion , cerebrovascular accident , or stent thrombosis did not differ between the study groups ; however , there was a consistently greater risk of hemorrhage in the 24-month clopidogrel group according to all prespecified bleeding definitions , including the recently proposed Bleeding Academic Research Consortium classification . Conclusions — A regimen of 24 months of clopidogrel therapy in patients who had received a balanced mixture of drug-eluting or bare-metal stents was not significantly more effective than a 6-month clopidogrel regimen in reducing the composite of death due to any cause , myocardial infa rct ion , or cerebrovascular accident . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00611286
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 .