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 .
Impact of Clopidogrel Plus Aspirin Versus Aspirin Alone on the Progression of Native Coronary Artery Disease After Bypass Surgery: Analysis From the Clopidogrel After Surgery for Coronary Artery DiseasE (CASCADE) Randomized Trial
Background — The effects of dual antiplatelet therapy with aspirin and clopidogrel on the progression of native coronary artery disease after coronary artery bypass grafting are unknown . Methods and Results — In the Clopidogrel After Surgery for Coronary Artery DiseasE ( CASCADE ) trial , a total of 113 patients were r and omized to receive aspirin plus clopidogrel or aspirin plus placebo for 1 year after coronary artery bypass grafting . In this secondary analysis , the 92 patients who underwent preoperative and 1-year postoperative angiograms at 2 centers had each of their coronary stenoses grade d serially by using 6 thresholds ( grade 0 [ 0%–24 % ] , grade 1 [ 25%–37 % ] , grade 2 [ 38%–62 % ] , grade 3 [ 63%–82 % ] , grade 4 [ 83%–98 % ] , and grade 5 [ 99%–100 % ] ) . We compared the incidence and degree of evolving coronary artery disease between the 2 treatment groups . A total of 543 preoperative stenoses and occlusions were quantified and followed . At 1-year postoperatively , there were 103 evolving ( 94 worsened , 9 improved ) and 22 new lesions . The right coronary artery territory and sites proximal to a graft were more commonly associated with worsening coronary artery disease ( P⩽0.02 ) . There were no differences in clinical events between treatment groups , and the proportion of patients with evolving or new lesions was also similar ( 70 % versus 74 % , aspirin – clopidogrel versus aspirin – placebo , respectively ; P=0.8 ) . However , in evolving or new lesions , the mean grade change ( 1.1±1.0 versus 1.6±1.1 , respectively ; P=0.01 ) and the proportion of new occlusions ( 7 % versus 22 % ; P=0.02 ) were lower in the aspirin – clopidogrel group . Conclusions — The addition of clopidogrel to aspirin correlates with less worsening of native coronary artery disease 1 year after coronary artery bypass grafting . These findings may help guide post – coronary artery bypass grafting antiplatelet therapy . 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 .