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 .
Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation.
BACKGROUND A substantial proportion of patients receiving fibrinolytic therapy for myocardial infa rct ion with ST-segment elevation have inadequate reperfusion or reocclusion of the infa rct -related artery , leading to an increased risk of complications and death . METHODS We enrolled 3491 patients , 18 to 75 years of age , who presented within 12 hours after the onset of an ST-elevation myocardial infa rct ion and r and omly assigned them to receive clopidogrel ( 300-mg loading dose , followed by 75 mg once daily ) or placebo . Patients received a fibrinolytic agent , aspirin , and when appropriate , heparin ( dispensed according to body weight ) and were scheduled to undergo angiography 48 to 192 hours after the start of study medication . The primary efficacy end point was a composite of an occluded infa rct -related artery ( defined by a Thrombolysis in Myocardial Infa rct ion flow grade of 0 or 1 ) on angiography or death or recurrent myocardial infa rct ion before angiography . RESULTS The rates of the primary efficacy end point were 21.7 percent in the placebo group and 15.0 percent in the clopidogrel group , representing an absolute reduction of 6.7 percentage points in the rate and a 36 percent reduction in the odds of the end point with clopidogrel therapy ( 95 percent confidence interval , 24 to 47 percent ; P<0.001 ) . By 30 days , clopidogrel therapy reduced the odds of the composite end point of death from cardiovascular causes , recurrent myocardial infa rct ion , or recurrent ischemia leading to the need for urgent revascularization by 20 percent ( from 14.1 to 11.6 percent , P=0.03 ) . The rates of major bleeding and intracranial hemorrhage were similar in the two groups . CONCLUSIONS In patients 75 years of age or younger who have myocardial infa rct ion with ST-segment elevation and who receive aspirin and a st and ard fibrinolytic regimen , the addition of clopidogrel improves the patency rate of the infa rct -related artery and reduces ischemic complications
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 .