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 .
Benefit of clopidogrel according to timing of percutaneous coronary intervention in patients with acute coronary syndromes: further results from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study.
BACKGROUND The CURE study demonstrated the benefit of clopidogrel in patients with non-ST elevation ( NSTE ) acute coronary syndromes ( ACSs ) , including those undergoing percutaneous coronary intervention ( PCI ) . It did not report the relation between clopidogrel and timing of PCI or , more specifically , the role of clopidogrel in patients managed with an early interventional strategy , the current preferred treatment option for patients with NSTE ACSs . In the present study , we examined the relation between  clopidogrel therapy , timing of PCI , and cardiovascular ( CV ) events in patients participating in the CURE study . METHODS A total of 12562 patients with NSTE ACSs was r and omized in double-blind fashion to clopidogrel or placebo ( 300 mg loading dose , then 75 mg/d ) in addition to aspirin for up to 1 year . We analyzed the data of the 2658 CURE patients undergoing PCI and related the incidence of outcome events ( CV death/myocardial infa rct ion [ MI ] )  to timing of PCI after r and omization : early ( < 48 hours , median 1.0 day , n = 370 ) , intermediate ( > or = 48 hours to initial hospital discharge , median 6.8 days , n = 1360 ) , and late ( after initial hospital discharge , median 47.6 days , n = 928 ) . RESULTS Clopidogrel showed consistent treatment benefit over the 12-month ( mean 9 months ) follow-up period irrespective of timing of PCI ( relative risk [ RR ] 0.53 for the early group , RR 0.72 for the intermediate group , RR 0.70 for the late group ) . After adjustment for propensity to undergo PCI , the greatest treatment benefit of clopidogrel was observed in patients undergoing PCI < 48 hours after r and omization ( RR 0.45 , 95 % CI 0.21 - 0.96 , P = .038 ) , although with overlap between groups . The lowest absolute event rate ( 6.7 % CV death/MI ) was observed in patients treated with clopidogrel and undergoing PCI within 48 hours . There was no increased risk of major bleeding in the early PCI group . CONCLUSIONS The benefit of therapy with clopidogrel in addition to aspirin in patients presenting with NSTE ACSs was significant irrespective of the timing of PCI . The combination of clopidogrel and an early ( < 48 hours ) interventional strategy was associated with low absolute event rates for CV death/nonfatal MI
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 .