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 for optimal platelet inhibition following off-pump coronary artery bypass surgery: results from the CRYSSA (prevention of Coronary arteRY bypaSS occlusion After off-pump procedures) randomised study
Objective To determine the individual variability in the response to aspirin and /or clopidogrel and its impact on graft patency after off-pump coronary artery bypass grafting . Design A single-centre prospect i ve r and omised controlled study design ed according to the Consoli date d St and ards of Reporting Trials statement . R and omisation was obtained by a computer-generated algorithm . Setting University medical school in Italy . Patients 300 patients who underwent off-pump coronary artery bypass grafting were r and omised to receive aspirin ( n=150 ) or aspirin plus clopidogrel ( n=150 ) . Intervention Aspirin 100 mg or aspirin 100 mg plus clopidogrel 75 mg daily was initiated when postoperative chest tube drainage was ≤50 ml/h for 2 h and patients were followed up for 12 months . Main outcome measures Qualitative and quantitative assessment of platelet function , angiographic evaluation of coronary revascularisation by 64-slice CT and clinical outcome . Results In the aspirin group , 49 patients ( 32.6 % ) were aspirin resistant and , in the aspirin-clopidogrel group , 19 patients ( 12.6 % ) were aspirin and clopidogrel resistant . The platelet response to aspirin  was similar in all aspirin responders despite the study arm ( Aspirin Reaction Units 313.2±44.8 vs 323.6±53.6 ; p=0.07 ) . The platelet response to clopidogrel  was enhanced by aspirin in patients responsive to both aspirin and clopidogrel ( synergistic effect ) compared with responders to clopidogrel only ( P2Y12 Reaction Units 139.9±15.5 vs 179.4±18.5 ; p<0.001 ) . Combined therapy was associated with a reduced vein graft occlusion rate ( 7.4 % vs 13.1 % ; p=0.04 ) . Antiplatelet resistance was a predictor of graft occlusion ( RR 3.6 , 95 % CI 2.5 to 6.9 ; p<0.001 ) . Synergistic aspirin and clopidogrel activity was a strong predictor of vein graft patency ( RR 5.1 , 95 % CI 1.4 to 16.3 ; p<0.01 ) . Conclusions Combined clopidogrel and aspirin overcome single drug resistances , are safe for bleeding and improve venous graft patency
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 .