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 .
Optimal timing for the initiation of pre-treatment with 300 mg clopidogrel before percutaneous coronary intervention.
OBJECTIVES This study sought to determine the optimal timing of a 300-mg clopidogrel loading dose before percutaneous coronary intervention ( PCI ) in patients enrolled in the Clopidogrel for the Reduction of Events During Observation ( CREDO ) trial . BACKGROUND A loading dose of clopidogrel before a PCI has become relatively commonplace , although the data supporting this practice are limited and sometimes conflicting . METHODS Patients were r and omized to receive either  300 mg clopidogrel or a matching placebo administered a minimum of 3 h and a maximum of 24 h before PCI . The primary 28-day combined end point was death , myocardial infa rct ion , or urgent target vessel revascularization . Linear splines were used to summarize the effect of the time of pre-treatment as a continuous variable . RESULTS A total of 1,762 patients were evaluated . For patients r and omized to placebo , there was no relationship between the duration of pre-treatment and the occurrence of the primary end point , whereas longer duration s of pre-treatment in patients r and omized to clopidogrel were associated with improved outcomes . The event rates diverged maximally at 24 h. The difference in outcomes between placebo and clopidogrel pre-treated patients was not significant until > or = 15 h pre-treatment , with a 58.8 % ( p = 0.028 ) reduction in the primary end point in patients pre-treated with clopidogrel > or = 15 h compared with placebo . CONCLUSIONS When a 300-mg loading dose of clopidogrel is used , little benefit is obtained compared with just 75 mg at the time of the PCI when the treatment duration is < 12 h. In patients pre-treated for longer duration s , the optimal duration seems to approach 24
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 .