Key result
Dual antiplatelet therapy with clopidogrel and aspirin did not significantly lower the rate of myocardial infarction, stroke, or cardiovascular death compared to placebo plus aspirin.
Why the study?
Does dual antiplatelet therapy with clopidogrel and aspirin reduce the composite of myocardial infarction, stroke, and death from cardiovascular causes in patients at risk of atherothrombotic events?
Does dual antiplatelet therapy with clopidogrel and aspirin reduce the composite of myocardial infarction, stroke, and death from cardiovascular causes in patients at risk of atherothrombotic events?
Answers are grounded in this paper and cite their sources.
Routine use of dual antiplatelet therapy with clopidogrel and aspirin is not superior to aspirin alone for broad atherothrombotic risk reduction, though secondary prevention subgroups with prior events may benefit.
The Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) study (N Engl J Med 2006; 354:1706-1717, J Am Coil Cardiol 2007; 49:1982-1988) assessed the effect of dual antiplatelet therapy with clopidogrel (Plavix) and aspirin in patients at risk of atherothrombotic events. At a median of 28 months, the rate of the primary efficacy end point (a composite of myocardial infarction, stroke, and death from cardiovascular causes) was not significantly lower in the group receiving clopidogrel plus aspirin than in the group receiving placebo plus aspirin. However, one subgroup may have derived some benefit from the combination: those at higher risk owing to a history of myocardial infarction, ischemic stroke, or symptomatic peripheral arterial disease.
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Bakhru et al. (2008) conducted a review in At risk of atherothrombotic events. Clopidogrel and aspirin vs. Placebo plus aspirin was evaluated on Composite of myocardial infarction, stroke, and death from cardiovascular causes. Dual antiplatelet therapy with clopidogrel and aspirin did not significantly lower the rate of myocardial infarction, stroke, or cardiovascular death compared to placebo plus aspirin.
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