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 .
The Effectiveness of Dual Antiplatelet Treatment in Acute Ischemic Stroke Patients with Intracranial Arterial Stenosis: A Subgroup Analysis of CLAIR Study
Background Dual antiplatelet therapy with clopidogrel and aspirin reduces the presence and number of microembolic signals in patients with large artery disease . However , whether it is effective in patients with intracranial disease alone remains uncertain . We performed a subgroup analysis of the The CLopidogrel plus Aspirin for Infa rct ion Reduction ( CLAIR in acute stroke or transient ischemic attack patients with large artery stenosis and microembolic signals ) study of only patients with intracranial occlusive disease , excluding those with extra cranial disease . Methods CLAIR was a r and omized-controlled , open-label , multicenter clinical trial with blinded outcome evaluation , which recruited patients with symptoms of ischemic stroke or transient ischemic attack within seven-days of onset , with large artery stenosis verified by transcranial Doppler and carotid ultrasound , and with microembolic signals detected by transcranial Doppler recording . All patients were r and omized to receive clopidogrel plus aspirin daily for seven-days ( dual treatment ) , or aspirin alone for seven-days ( monotherapy ) . Repeated transcranial Doppler recordings for microembolic signals were made on day one , two , and seven . This subgroup study only analyzed the patients with purely intracranial large artery disease and excluded those with extra cranial stenosis . Results There were 70 patients recruited with purely intracranial stenosis , 34 in the dual treatment group and 36 in the monotherapy group . The proportion of the patients with positive emboli at day seven in the dual treatment group was significantly lower than that in the monotherapy group ( relative risk reduction 56·5 % , 95 % confidence interval 2·5–80·6 ; P = 0·029 ) . The number of emboli in the dual treatment group decreased significantly at day two ( P = 0·043 ) and day seven ( P = 0·018 ) compared with the monotherapy group . After adjustment for the number of emboli at day one , the effect of dual treatment was still significant for the reduction of presence ( relative risk reduction 56·0 % ; 95 % confidence interval 5·4–79·6 ; P = 0·036 ) and number ( adjusted mean difference −0·9 ; 95 % confidence interval −1·5 to −0·3 ; P = 0·004 ) of positive emboli at day seven . Conclusions Dual treatment with clopidogrel and aspirin for seven-days is more effective than aspirin alone to reduce microembolic signals in patients with intracranial arterial stenosis
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 .