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 .
Effects of clopidogrel added to aspirin in patients with recent lacunar stroke.
BACKGROUND Lacunar infa rcts are a frequent type of stroke caused mainly by cerebral small-vessel disease . The effectiveness of antiplatelet therapy for secondary prevention has not been defined . METHODS We conducted a double-blind , multicenter trial involving 3020 patients with recent symptomatic lacunar infa rcts identified by magnetic resonance imaging . Patients were r and omly assigned to receive 75 mg of clopidogrel or placebo daily ; patients in both groups received 325 mg of aspirin daily . The primary outcome was any recurrent stroke , including ischemic stroke and intracranial hemorrhage . RESULTS The participants had a mean age of 63 years , and 63 % were men . After a mean follow-up of 3.4 years , the risk of recurrent stroke was not significantly reduced with aspirin and clopidogrel ( dual antiplatelet therapy ) ( 125 strokes ; rate , 2.5 % per year ) as compared with aspirin alone ( 138 strokes , 2.7 % per year ) ( hazard ratio , 0.92 ; 95 % confidence interval [ CI ] , 0.72 to 1.16 ) , nor was the risk of recurrent ischemic stroke ( hazard ratio , 0.82 ; 95 % CI , 0.63 to 1.09 ) or disabling or fatal stroke ( hazard ratio , 1.06 ; 95 % CI , 0.69 to 1.64 ) . The risk of major hemorrhage was almost doubled with dual antiplatelet therapy ( 105 hemorrhages , 2.1 % per year ) as compared with aspirin alone ( 56 , 1.1 % per year ) ( hazard ratio , 1.97 ; 95 % CI , 1.41 to 2.71 ; P<0.001 ) . Among classifiable recurrent ischemic strokes , 71 % ( 133 of 187 ) were lacunar strokes . All-cause mortality was increased among patients assigned to receive dual antiplatelet therapy ( 77 deaths in the group receiving aspirin alone vs. 113 in the group receiving dual antiplatelet therapy ) ( hazard ratio , 1.52 ; 95 % CI , 1.14 to 2.04 ; P=0.004 ) ; this difference was not accounted for by fatal hemorrhages ( 9 in the group receiving dual antiplatelet therapy vs. 4 in the group receiving aspirin alone ) . CONCLUSIONS Among patients with recent lacunar strokes , the addition of clopidogrel to aspirin did not significantly reduce the risk of recurrent stroke and did significantly increase the risk of bleeding and death . ( Funded by the National Institute of Neurological Disorders and Stroke and others ; SPS3 Clinical Trials.gov number , NCT00059306 . )
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 .