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 .
Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial.
OBJECTIVE Dual antiplatelet therapy with clopidogrel plus acetylsalicylic acid ( ASA ) is superior to ASA alone in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention . We sought to determine whether clopidogrel plus ASA conferred benefit on limb outcomes over ASA alone in patients undergoing below-knee bypass grafting . METHODS Patients undergoing unilateral , below-knee bypass graft for atherosclerotic peripheral arterial disease ( PAD ) were enrolled 2 to 4 days after surgery and were r and omly assigned to clopidogrel 75 mg/day plus ASA 75 to 100 mg/day or placebo plus ASA 75 to 100 mg/day for 6 to 24 months . The primary efficacy endpoint was a composite of index-graft occlusion or revascularization , above-ankle amputation of the affected limb , or death . The primary safety endpoint was severe bleeding ( Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries [ GUSTO ] classification ) . RESULTS In the overall population , the primary endpoint occurred in 149 of 425 patients in the clopidogrel group vs 151 of 426 patients in the placebo ( plus ASA ) group ( hazard ratio [ HR ] , 0.98 ; 95 % confidence interval [ CI ] , 0.78 - 1.23 ) . In a prespecified subgroup analysis , the primary endpoint was significantly reduced by clopidogrel in prosthetic graft patients ( HR , 0.65 ; 95 % CI , 0.45 - 0.95 ; P = .025 ) but not in venous graft patients ( HR , 1.25 ; 95 % CI , 0.94 - 1.67 , not significant [ NS ] ) . A significant statistical interaction between treatment effect and graft type was observed ( P(interaction ) = .008 ) . Although total bleeds were more frequent with clopidogrel , there was no significant difference between the rates of severe bleeding in the clopidogrel and placebo ( plus ASA ) groups ( 2.1 % vs 1.2 % ) . CONCLUSION The combination of clopidogrel plus ASA did not improve limb or systemic outcomes in the overall population of PAD patients requiring below-knee bypass grafting . Subgroup analysis suggests that clopidogrel plus ASA confers benefit in patients receiving prosthetic grafts without significantly increasing major bleeding risk
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 .