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 .
Long-term cost-effectiveness of early and sustained clopidogrel therapy for up to 1 year in patients undergoing percutaneous coronary intervention after presenting with acute coronary syndromes without ST-segment elevation.
BACKGROUND The superiority of clopidogrel and aspirin versus aspirin alone for up to 1 year in patients who undergo percutaneous coronary intervention ( PCI ) after presenting with acute coronary syndromes without ST-segment elevation was demonstrated in the PCI-CURE study . We evaluated the long-term cost-effectiveness of clopidogrel use for up to 1 year using patient-level outcomes and re source use from PCI-CURE , and estimates of life expectancy gains based on external sources . METHODS PCI-CURE involved 2658 patients who underwent PCI between 1998 and 2000 after being r and omized in the CURE trial to clopidogrel ( n = 1313 ) or placebo ( n = 1345 ) . Roughly two thirds ( clopidogrel n = 821 , placebo n = 909 ) underwent PCI during the initial hospitalization ( early PCI ) . Costs were applied to hospitalizations according to diagnosis-related group . Clopidogrel was assigned the average wholesale price of 3.22 dollars per day . Life expectancy gains result ing from the prevention of major clinical events were estimated using external sources . RESULTS Average total costs were higher with clopidogrel ( difference [ based on costing method ] 253 dollars-423 dollars ) . For patients who underwent PCI during the initial hospitalization , the difference ranged from 155 dollars lower to 90 dollars higher with clopidogrel . The estimated life expectancy gain with clopidogrel was 0.0885 years , whereas it was 0.0962 years for the early PCI subgroup . Incremental cost per year of life gained with clopidogrel ranges from 2856 dollars to 4775 dollars overall and from dominant ( life expectancy benefit with cost savings ) to 935 dollars for the early PCI subgroup . CONCLUSIONS Clopidogrel given for up to 1 year in patients undergoing PCI after presentation with acute coronary syndromes is a highly cost-effective treatment strategy
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 .