Thienopyridines or Aspirin to Prevent Stroke and Other Serious Vascular Events in Patients at High Risk of Vascular Disease?
Key result
Thienopyridines reduced the odds of vascular events by 9% compared with aspirin (OR 0.91; 95% CI 0.84-0.98; P=0.01) in patients at high risk of vascular disease.
Why the study?
Do thienopyridines reduce vascular events compared to aspirin in patients at high risk of vascular disease?
Population
22,656 patients at high risk of vascular disease pooled from 4 randomized trials
Comparison
Thienopyridines (ticlopidine or clopidogrel) vs Aspirin
Design
Meta-analysis
Follow-up
approximately 2 years
Authors
Discussion
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Implication
Supports thienopyridines over aspirin for vascular prevention in high-risk patients; reinforces meta-analytic evidence of modest benefit.
Study Design
Type
Systematic Review (n=22,656)
Structured PICO
Do thienopyridines reduce vascular events compared to aspirin in patients at high risk of vascular disease?
P
Population
22,656 patients at high risk of vascular disease (including 9,840 presenting with a transient ischemic attack/ischemic stroke) pooled from 4 randomized trials
I
Intervention
Thienopyridines (ticlopidine or clopidogrel)
C
Comparator
Aspirin
O
Outcome
Vascular events (composite of stroke, myocardial infarction, or vascular death)composite
Main Result
Effect estimate: OR 0.91 (95% CI 0.84 to 0.98)
p-value: p=0.01
Thienopyridines are modestly more effective than aspirin in preventing serious vascular events in high-risk patients, with clopidogrel offering a safer alternative to ticlopidine for those unable to tolerate aspirin.
Limitations
- Insufficient information to determine which particular types of patients would benefit most, and which least, from clopidogrel instead of aspirin.
- Insufficient information to determine which particular types of patients would benefit most, and which least, from clopidogrel instead of aspirin
Cite This Study
Hankey et al. (2000) conducted a systematic review in High risk of vascular disease (n=22,656). Thienopyridines (ticlopidine and clopidogrel) vs. Aspirin was evaluated on Vascular events (stroke, myocardial infarction, or vascular death) (OR 0.91, 95% CI 0.84 to 0.98, p=0.01). Thienopyridines reduced the odds of vascular events by 9% compared with aspirin (OR 0.91; 95% CI 0.84-0.98; P=0.01) in patients at high risk of vascular disease.