Key result
Dual antiplatelet therapy with clopidogrel plus aspirin supports secondary prevention of ischemic events but may not be more effective than aspirin alone in primary prevention.
Why the study?
Does antiplatelet therapy (clopidogrel and/or aspirin) reduce atherothrombotic events in high-risk patients?
Does antiplatelet therapy (clopidogrel and/or aspirin) reduce atherothrombotic events in high-risk patients?
Dual antiplatelet therapy with clopidogrel and aspirin is beneficial for secondary prevention of atherothrombotic events, but its role in primary prevention remains unsupported compared to aspirin alone.
Supports secondary prevention with clopidogrel plus aspirin; leaves open its advantage over aspirin alone for primary prevention.
Atherothrombosis describes the superimposition of a thrombus on a ruptured atherosclerotic plaque, and is the primary cause of acute ischemic events. Atherothrombosis is a generalized and progressive process with an inflammatory component. Patients with disease in one vascular bed are at risk of disease in another, a concept known as "cross-risk." Platelet adhesion, activation, and aggregation in the final stage of atherothrombosis are ultimately responsible for arterial occlusion and consequent ischemia. Therefore, antiplatelet therapy is an effective treatment choice for secondary prevention. Clopidogrel, an adenosine diphosphate receptor antagonist, given alone or in combination with aspirin, may benefit secondary prevention of ischemic events. Current treatment guidelines suggest the use of a combination of these two agents for secondary prevention where appropriate. However, data conflict regarding the efficacy of antiplatelet therapy for primary prevention. A recent meta-analysis demonstrated that aspirin significantly reduces the risk of first myocardial infarction in both men and women. The recent Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance trial, which evaluated the effects of clopidogrel plus aspirin compared with aspirin alone, seems to support the use of dual antiplatelet therapy in secondary prevention, but suggests that it may not be more effective than aspirin alone in primary prevention.
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Samer Ellahham (2008) conducted a review in Atherothrombotic events in high-risk patients. Antiplatelet therapy (clopidogrel and/or aspirin) was evaluated. Dual antiplatelet therapy with clopidogrel plus aspirin supports secondary prevention of ischemic events but may not be more effective than aspirin alone in primary prevention.
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