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 .
Benefits and Risks of the Combination of Clopidogrel and Aspirin in Patients Undergoing Surgical Revascularization for Non–ST-Elevation Acute Coronary Syndrome: The Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) Trial
Background —Antiplatelet therapy and antithrombin therapy have been demonstrated to reduce the risk of cardiac events in patients presenting with acute coronary syndrome , yet all effective therapies also increase the risk of bleeding . Methods and Results —In the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events ( CURE ) trial , 12 562 patients were r and omized to clopidogrel or placebo  in addition to  aspirin  , and the primary outcome was cardiovascular ( CV ) death , myocardial infa rct ion ( MI ) , or stroke . The benefits were consistent among those undergoing percutaneous coronary intervention ( PCI ) [ 9.6 % for clopidogrel , 13.2 % for placebo ; relative risk ( RR ) , 0.72 ; 95 % CI , 0.57 to 0.90 ] , coronary artery bypass grafting ( CABG ) surgery ( 14.5 % for clopidogrel 16.2 % for placebo ; RR , 0.89 ; 95 % CI , 0.71 to 1.11 ) , and medical therapy only ( 8.1 % for clopidogrel , 10.0 % for placebo ; RR , 0.80 ; 95 % CI , 0.69 to 0.92 ; test for interaction among strata , 0.53 ) . For CABG during the initial hospitalization ( 530 for placebo , 485 for clopidogrel ) , the frequency of CV death , MI or stroke before CABG was 4.7 % for placebo and 2.9 % for clopidogrel ( RR , 0.56 ; 95 % CI , 0.29 to 1.08 ) . For the entire study , there was a 1 % excess of major bleeding but no significant excess of life-threatening bleeding . Among patients undergoing CABG , the rates of life-threatening bleeding were 5.6 % for clopidogrel and 4.2 % for placebo ( RR , 1.30 ; 95 % CI , 0.91 to 1.95 ; both nonsignificant ) . Conclusions —The benefits versus risks of early and long-term clopidogrel therapy ( freedom from CV death , MI , stroke , or life-threatening bleeding ) are similar in those undergoing revascularization ( CABG or PCI ) and in the study population as a whole . Overall , the benefits of starting clopidogrel on admission appear to outweigh the risks , even among those who proceed to CABG during the initial hospitalization
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 .