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 .
Aspirin Plus Clopidogrel Versus Aspirin Alone After Coronary Artery Bypass Grafting: The Clopidogrel After Surgery for Coronary Artery Disease (CASCADE) Trial
Background — Clopidogrel inhibits intimal hyperplasia in animal studies and therefore may reduce saphenous vein graft ( SVG ) intimal hyperplasia after coronary artery bypass grafting . The Clopidogrel After Surgery for Coronary Artery DiseasE ( CASCADE ) study was undertaken to evaluate whether the addition of clopidogrel to aspirin inhibits SVG disease after coronary artery bypass grafting , as assessed at 1 year by intravascular ultrasound . Methods and Results — In this double-blind phase II trial , 113 patients undergoing coronary artery bypass grafting with SVGs were r and omized to receive aspirin 162 mg plus clopidogrel 75 mg daily or aspirin 162 mg plus placebo daily for 1 year . The primary outcome was SVG intimal hyperplasia ( mean intimal area ) as determined by intravascular ultrasound at 1 year . Secondary outcomes were graft patency , major adverse cardiovascular events , and major bleeding . One-year intravascular ultrasound and coronary angiography were performed in 92 patients ( 81.4 % ) . At 1 year , SVG intimal area did not differ significantly between the 2 groups ( 4.1±2.0 versus 4.5±2.1 mm2 , aspirin-clopidogrel versus aspirin-placebo , P=0.44 ) . Overall 1-year graft patency was 95.2 % in the aspirin-clopidogrel group compared with 95.5 % in the aspirin-placebo group ( P=0.90 ) , and SVG patency was 94.3 % in the aspirin-clopidogrel group versus 93.2 % in the aspirin-placebo group ( P=0.69 ) . Freedom from major adverse cardiovascular events at 1 year was 92.9±3.4 % in the aspirin-clopidogrel group and 91.1±3.8 % in the aspirin-placebo group ( P=0.76 ) . The incidence of major bleeding at 1 year was similar for the 2 groups ( 1.8 % versus 0 % , aspirin-clopidogrel versus aspirin-placebo , P=0.50 ) . Conclusions — Compared with aspirin monotherapy , the combination of aspirin plus clopidogrel did not significantly reduce the process of SVG intimal hyperplasia 1 year after coronary artery bypass grafting . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00228423
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 .