Key result
Aspirin plus clopidogrel cuts 6-month death, MI, and recurrent ischemia ~75% vs. aspirin alone.
Why the study?
The comparative effectiveness of aspirin, clopidogrel, and their combination in secondary prevention of acute coronary syndromes was not fully established.
Does the combination of aspirin and clopidogrel or clopidogrel alone reduce recurrent ischemia and cardiovascular events in patients with acute coronary syndrome compared to aspirin alone?
RCT (n=150)
randomized
No
Does the combination of aspirin and clopidogrel or clopidogrel alone reduce recurrent ischemia and cardiovascular events in patients with acute coronary syndrome compared to aspirin alone?
Absolute Event Rate: 10.6% vs 42.5%
p-value: p=<0.001
The combination of aspirin and clopidogrel is significantly more effective than either drug alone for the secondary prevention of acute coronary syndromes.
Supports dual antiplatelet therapy over monotherapy for ACS secondary prevention; extends evidence favoring aspirin-clopidogrel combination regimens.
Background: The term ACS applies to a category of clinical symptoms associated with acute myocardial infarction that spans the continuum of clinical conditions from severe angina to NSTEMI to STEMI.It is due to decreased blood flow in the arteries of the coronary so that part of the heart muscle cannot function properly or dies.Methods: It was prospective study.Patients presenting with unstable angina, non ST elevation myocardial infarction and ST elevation myocardial infarction were randomly selected from the outdoor and indoor of the department of Medicine M.G.M. Medical College and L.S.K. Hospital.Between January 2018 and December 2018.150 patients of ACS were included in this study.50 patients were randomised to receive aspirin (Group A), 50 patients received clopidogrel in (Group B) and 50 patients received the combination of aspirin and clopidogrel (Group C).Results: In our study, reduction of end points of MI, recurrent ischaemia, cardiac death and revascularisation was marginally better with clopidogrel (31.3%) than aspirin (42.5%) which was not significant p>0.05.This discrepancy between two studies may be due to differences in population under study, end points, duration of study, and number of patients.Conclusion: Combination of aspirin and clopidogrel is significantly more effective than either drug alone in secondary prevention of acute coronary syndromes.This benefit is evident at 30 days and it becomes more significant at 6 months.
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Nishant Kumar Singh (2020) conducted an RCT in Acute coronary syndrome (n=150). Aspirin and clopidogrel combination vs. Aspirin alone was evaluated on Composite of death, myocardial infarction, and recurrent ischemia at 6 months (p=<0.001). The combination of aspirin and clopidogrel significantly reduced the 6-month composite endpoint of death, MI, and recurrent ischemia to 10.6% compared to 42.5% with aspirin alone (p<0.001).
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