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 .
Recurrent Ischemic Lesions After Acute Atherothrombotic Stroke: Clopidogrel Plus Aspirin Versus Aspirin Alone
Background and Purpose — In patients with acute ischemic stroke caused by large artery atherosclerosis , clopidogrel plus aspirin versus aspirin alone might be more effective to prevent recurrent cerebral ischemia . However , there is no clear evidence . Methods — In this multicenter , double-blind , placebo-controlled trial , we r and omized 358 patients with acute ischemic stroke of presumed large artery atherosclerosis origin within 48 hours of onset to clopidogrel ( 75 mg/d without loading dose ) plus aspirin ( 300-mg loading followed by 100 mg/d ) or to aspirin alone ( 300-mg loading followed by 100 mg/d ) for 30 days . The primary outcome was new symptomatic or asymptomatic ischemic lesion on magnetic resonance imaging within 30 days . Secondary outcomes were 30-day functional disability , clinical stroke recurrence , and composite of major vascular events . Safety outcome was any bleeding . Results — Of 358 patients enrolled , 334 ( 167 in each group ) completed follow-up magnetic resonance imaging . The 30-day new ischemic lesion recurrence rate was comparable between the clopidogrel plus aspirin and the aspirin monotherapy groups ( 36.5 % versus 35.9 % ; relative risk , 1.02 ; 95 % confidence interval , 0.77–1.35 ; P=0.91 ) . Of the recurrent ischemic lesions , 94.2 % were clinical ly asymptomatic . There were no differences in secondary outcomes between the 2 groups . Any bleeding were more frequent in the combination group than in the aspirin monotherapy group , but the difference was not significant ( 16.7 % versus 10.7 % ; P=0.11 ) . One hemorrhagic stroke occurred in the clopidogrel plus aspirin group . Conclusions — Clopidogrel plus aspirin might not be superior to aspirin alone for preventing new ischemic lesion and clinical vascular events in patients with acute ischemic stroke caused by large artery atherosclerosis . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00814268
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 .