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 .
Extracardiac vascular disease and effectiveness of sustained clopidogrel treatment
Objective : To assess the effectiveness of long term treatment with clopidogrel of patients with extracardiac vascular disease ( ECVD ) ( a history of either peripheral arterial disease or cerebrovascular disease ) . Design : Subgroup analysis of a prospect i ve r and omised clinical trial . Setting : The CREDO ( clopidogrel for the reduction of events during observation ) trial was a r and omised , double blind , placebo controlled trial conducted at 99 centres in North America from June 1999 through April 2001 . Patients : 2116 patients who were to undergo elective coronary intervention or were deemed at high likelihood of undergoing percutaneous coronary intervention were enrolled in the CREDO trial . The current study sample consisted of 272 patients with ECVD . Main outcome measure : One year incidence of the composite of death , myocardial infa rct ion , or stroke in the intent to treat population . Results : Patients with ECVD had a more than twofold greater relative risk reduction  with clopidogrel for the primary end point compared with patients without ECVD ( 47.9 % , 95 % confidence interval ( CI ) −4.2 % to 73.9 % , v 18.2 % , 95 % CI −10.5 % to 39.5 % , respectively ) . Conclusions : Longer term clopidogrel treatment provides added protection against thrombotic events throughout the arterial vasculature , not limited to the coronary arteries , and may be especially effective for patients with more diffuse atherosclerosis such as ECVD
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 .