Key result
Clopidogrel has not been proven as a lifesaving drug in ischemic heart disease, may increase mortality in genetically poor metabolizers, and is associated with an increased risk of bleeding.
Why the study?
The comparative effectiveness of clopidogrel alone or combined with aspirin versus aspirin alone in various ischemic heart disease populations remains to be critically appraised.
Does clopidogrel alone or combined with aspirin reduce myocardial infarction, stroke, or vascular death compared to aspirin alone in patients with ischemic heart disease?
Does clopidogrel alone or combined with aspirin reduce myocardial infarction, stroke, or vascular death compared to aspirin alone in patients with ischemic heart disease?
Dual antiplatelet therapy with clopidogrel and aspirin is effective in ACS and PCI, but does not offer significant additional benefit over aspirin alone in stable coronary heart disease.
Answers are grounded in this paper and cite their sources.
Challenges routine clopidogrel addition in stable ischemic heart disease; leaves open genotype-stratified trials on net mortality benefit.
Aspirin and clopidogrel are the commonest dual antiplatelet agents being used in the secondary prevention of cardiovascular disease. In high risk patients with coronary heart disease, the use of aspirin was associated with a significant risk reduction of myocardial infarction, stroke and vascular death. The use of clopidogrel alone was slightly superior to aspirin, and associated with reduced risk of vascular death, ischemic stroke and myocardial infarction. Dual antiplatelet therapy has been well studied in patients with acute coronary syndrome and those undergoing percutaneous coronary intervention (PCI). In patients with stable coronary heart disease or multiple risk factors the combination of clopidogrel plus aspirin was not significantly more effective than aspirin alone in reducing MI, stroke or death from cardiovascular causes.
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Alotaiby et al. (2013) conducted a review in Ischemic heart disease. Clopidogrel vs. Aspirin or placebo was evaluated. Clopidogrel has not been proven as a lifesaving drug in ischemic heart disease, may increase mortality in genetically poor metabolizers, and is associated with an increased risk of bleeding.
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