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 .
Bleeding Complications With Dual Antiplatelet Therapy Among Patients With Stable Vascular Disease or Risk Factors for Vascular Disease: Results From the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) Trial
Background — Uncertainty exists about the frequency , correlates , and clinical significance of bleeding with dual antiplatelet therapy ( DAPT ) , particularly over an extended period in a stable population . We sought to determine the frequency and time course of bleeding with DAPT in patients with established vascular disease or risk factors only ; identify correlates of bleeding ; and determine whether bleeding is associated with mortality . Methods and Results — We analyzed 15 603 patients enrolled in the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization , Management , and Avoidance ( CHARISMA ) trial , a double-blind , placebo-controlled , r and omized trial comparing long-term clopidogrel 75 mg/d versus placebo ;  all patients received aspirin ( 75 to 162 mg ) daily . Patients had either established stable vascular disease or multiple risk factors for vascular disease without established disease . Median follow-up was 28 months . Bleeding was assessed with the use of the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries ( GUSTO ) criteria . Severe bleeding occurred in 1.7 % of the clopidogrel group versus 1.3 % on placebo ( P=0.087 ) ; moderate bleeding occurred in 2.1 % versus 1.3 % , respectively ( P<0.001 ) . The risk of bleeding was greatest the first year . Patients without moderate or severe bleeding during the first year were no more likely than placebo-treated patients to have bleeding thereafter . The frequency of bleeding was similar in patients with established disease and risk factors only . In multivariable analysis , the relationship between moderate bleeding and all-cause mortality was strong ( hazard ratio , 2.55 ; 95 % confidence interval , 1.71 to 3.80 ; P<0.0001 ) , along with myocardial infa rct ion ( hazard ratio , 2.92 ; 95 % confidence interval , 2.04 to 4.18 ; P<0.0001 ) and stroke ( hazard ratio , 4.20 ; 95 % confidence interval , 3.05 to 5.77 ; P<0.0001 ) . Conclusions — In CHARISMA , there was an increased risk of bleeding with long-term clopidogrel . The incremental risk of bleeding was greatest in the first year and similar thereafter . Moderate bleeding was strongly associated with mortality . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00050817
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 .