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 .
Effect of Clopidogrel plus ASA vs. ASA Early after TIA and Ischaemic Stroke: A Substudy of the CHARISMA Trial
Background The Clopidogrel for High Atherothrombotic Risk and Ischaemic Stabilisation , Management and Avoidance ( CHARISMA ) trial reported no statistically significant benefit of adding clopidogrel to acetylsalicylic acid in the long-term management of a broad population of patients with stable vascular disease . However , a sub analysis raised the hypothesis that dual antiplatelet therapy with clopidogrel plus acetylsalicylic acid may be more effective than aspirin in patients with prior ischaemic stroke , myocardial infa rct ion of symptomatic peripheral arterial disease . We aim ed to determine whether the possible benefits of clopidogrel plus acetylsalicylic acid in patients with transient ischaemic attack and ischaemic stroke may be ‘ front-loaded ’ , and maximal within the first 30-days of r and omisation , without being unduly hazardous . Methods This was a sub analysis of a r and omised , double-blind , placebo-controlled trial of clopidogrel vs. placebo , in addition to background therapy with low-dose acetylsalicylic acid ( CHARISMA trial ) , restricted to all patients with transient ischaemic attack or ischaemic stroke . The primary efficacy outcome was stroke , and safety outcome severe bleeding , during the follow-up period . Results Among all transient ischaemic attack and ischaemic stroke patients r and omised to placebo ( n=2163 ) , 131 ( 6·1 % ) experienced a stroke during follow-up compared with 105 ( 4·9 % ) of 2157 patients assigned clopidogrel ( hazard ratio : 0·80 , 95 % confidence intervals : 0·62–1·03 ) . There was no significant difference in severe bleeding ( 1·7 % placebo vs. 1·9 % clopidogrel , hazard ratio : 1·11 , 95 % confidence intervals : 0·71–1·73 ) . Among all patients r and omised within 30-days of their qualifying transient ischaemic attack or ischaemic stroke to placebo ( n=667 ) , 46 ( 6·9 % ) experienced a stroke compared with 34 ( 5·1 % ) of 664 patients assigned clopidogrel ( hazard ratio : 0·74 , 0·46–1·16 ) . There was no significant difference in severe bleeding ( 1·6 % placebo vs. 1·4 % clopidogrel , hazard ratio : 0·83 , 95 % confidence intervals : 0·34–2·01 ) . Conclusion The data are consistent with , but do not prove the hypothesis that early addition of clopidogrel to acetylsalicylic acid in patients with transient ischaemic attack and ischaemic stroke of arterial origin may be more effective and acceptably safe compared with acetylsalicylic acid alone . Adequately powered clinical trials that are dedicated to exploring this hypothesis are needed
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 .