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 .
Preliminary Evidence of a High Risk of Bleeding on Aspirin plus Clopidogrel in Aspirin-Naïve Patients in the Acute Phase after TIA or Minor Ischaemic Stroke
Background : Aspirin plus clopidogrel ( A+C ) may be more effective than aspirin only ( AO ) acutely after TIA and minor stroke , but the risk of bleeding in the acute phase is uncertain . We determined this risk , focusing particularly on  aspirin-naïve patients . Methods : We studied consecutive referrals to the EXPRESS study clinic from 1/4/02 to 31/3/08 . A 30- to 90-day course of A+C was given to patients presenting acutely .  Bleeding events were identified by face-to-face follow-up , diagnostic coding , and blood transfusion data . Unpublished data from the FASTER pilot trial were also studied . Results : Among 633 EXPRESS patients treated with aspirin ( + /– clopidogrel )  , there were 12 spontaneous bleeds ( 6 minor , 6 major/life-threatening ) within 90 days after assessment , with a higher risk for A+C vs. AO ( 8/247 vs. 4/386 , p = 0.047 overall ; 5/247 vs. 1/386 , p = 0.03 for major/life-threatening bleeds ) . The excess of major/life-threatening bleeds on A+C vs. AO was seen in aspirin-naïve patients , ( 4/137 vs. 0/273 , p = 0.01 ) , but not in prior-aspirin patients ( 1/110 vs. 1/113 , p = 0.98 ) . All symptomatic bleeds in the FASTER pilot also occurred in aspirin-naïve patients r and omized to A+C ( 6/104 vs. 0/94 , p = 0.03 ) . In a pooled analysis , major/life-threatening bleeding on A+C occurred in 9/241 aspirin-naïve patients ( 90-day risk = 4.8 % , 1.6–8.0 ) versus 1/204 prior-aspirin patients ( p = 0.009 ) . Conclusion : Although based on relatively few outcomes , the high risk of major bleeding on A+C acutely after TIA or minor stroke in aspirin-naïve patients is a cause for concern . The potential risk to patients is sufficient to m and ate detailed monitoring of bleeding risk in ongoing trials and stratify results by whether patients were aspirin-naïve
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 .