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 .
Treatment Effect of Clopidogrel Plus Aspirin Within 12 Hours of Acute Minor Stroke or Transient Ischemic Attack
Background The aim of this study was to analyze the benefits and safety associated with the combination therapy of clopidogrel and aspirin among minor stroke or transient ischemic attack patients treated within 12 hours . Methods and Results This was a sub analysis of the CHANCE ( Clopidogrel in High‐Risk Patients with Acute Nondisabling Cerebrovascular Events ) trial , mainly limited to the prespecified group of patients r and omized within 12 hours to either the combination of clopidogrel plus aspirin or aspirin alone .  The primary outcome was ischemic stroke during 90‐day follow‐up . Recurrent ischemic stroke and progressive ischemic stroke were analyzed . Multivariable Cox modeling showed that r and omization within 12 hours was an independent predictor of ischemic stroke events ( hazard ratio [ 95 % CI ] 1.25 [ 1.04–1.49 ] , P=0.02 ) . Among 2573 patients r and omized within 12 hours , 282 ( 10.96 % ) patients had ischemic stroke events  . Among them , 158 ( 12.34 % ) of 1280 patients taking aspirin  experienced ischemic stroke compared with 124 ( 9.59 % ) of 1293 patients taking clopidogrel – aspirin ( P=0.02 ) . The dual antiplatelet was more effective than aspirin alone in reducing the risk of recurrent ischemic stroke ( 6.57 % versus 8.91 % , P=0.03 ) but not progressive ischemic stroke ( 3.02 % versus 3.43 % , P=0.28 ) . There was no significant difference in hemorrhagic events ( P=0.39 ) . Conclusions Among patients treated within 12 hours , the combination of clopidogrel and aspirin was more effective  than aspirin alone in reducing the risk of recurrent ischemic stroke during the 90‐day follow‐up and did not increase the hemorrhagic risk . Clinical Trial Registration URL : https://www . clinical trials.gov/. Unique identifier : NCT00979589
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 .