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 .
Dual Antiplatelets Reduce Microembolic Signals in Patients with Transient Ischemic Attack and Minor Stroke: Subgroup Analysis of CLAIR Study
Background Short course of dual antiplatelet therapy for early secondary prevention is a promising treatment for patients with minor stroke or transient ischemic attack at high risk of recurrence . Methods We examined the efficacy and safety of dual antiplatelets in patients with transient ischemic attack or minor stroke , defined as National Institute of Health Stroke Scale scores 0–3 , in a subgroup analysis of Clopidogrel plus aspirin versus Aspirin alone for Reducing embolization in patients with acute symptomatic cerebral or carotid artery stenosis ( CLAIR ) study .  Microembolic signals on transcranial Doppler monitoring was used as surrogate marker for recurrent stroke risk . Patients with ≥1 microembolic signals at baseline were r and omized to receive dual therapy ( aspirin 75–160 mg daily and clopidogrel 300 mg day 1 then 75 mg daily ) or monotherapy ( aspirin 75–160 mg daily ) for seven-days . Results Sixty-five of 100 patients recruited had transient ischemic attack or minor stroke : 30 received dual therapy and 35 received  monotherapy . Mean onset-to-r and omization was 2·3 days in dual therapy group and 3·2 days in monotherapy group ( P = 0·03 ) . At day 7 , the proportion of patients with ≥1 microembolic signals was 9 of 29 patients in dual therapy group and 18 of 34 patients in monotherapy group ( adjusted relative risk reduction 41·4 % , 95 % CI 29·8–51·1 , P < 0·001 ) . The median number of microembolic signals on day 7 was 0 in dual therapy group and 1·0 in monotherapy group ( P = 0·046 ) . No patients had intracranial or severe systemic hemorrhage . Conclusions Early dual therapy with clopidogrel and aspirin  reduces microembolic signals in patients with minor ischemic stroke or transient ischemic attack , without causing significant bleeding complications
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 .