Document Detail

Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease.
MedLine Citation:
PMID:  21249668     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Aspirin is the prophylactic antiplatelet drug of choice for people with cardiovascular disease. Adding a second antiplatelet drug to aspirin may produce additional benefit for those at high risk and those with established cardiovascular disease.
OBJECTIVES: To quantify the benefit and harm of adding clopidogrel to standard long-term aspirin therapy for preventing cardiovascular events in people at high risk of cardiovascular disease and those with established cardiovascular disease.
SEARCH STRATEGY: The searches have been updated: CENTRAL (Issue 3 2009), MEDLINE (2002 to September 2009) and EMBASE (2002 to September 2009).
SELECTION CRITERIA: All randomized controlled trials comparing long term use of aspirin plus clopidogrel with aspirin plus placebo or aspirin alone in patients with coronary disease, ischemic cerebrovascular disease, peripheral arterial disease, or at high risk of atherothrombotic disease were included.
DATA COLLECTION AND ANALYSIS: Data on mortality, non-fatal myocardial infarction, non-fatal stroke, unstable angina, heart failure, revascularizations, major and minor bleeding, and all adverse events were collected. The overall treatment effect was estimated by the pooled odds ratio (OR) with 95% confidence interval (CI) using a fixed-effect model (Mantel-Haenszel).
MAIN RESULTS: No new studies were identified from the updated searches. A total of two RCTs were found: the CHARISMA and the CURE study. The CURE study enrolled only patients with a recent non-ST segment elevation acute coronary syndrome. The use of clopidogrel plus aspirin, compared with placebo plus aspirin, was associated with a lower risk of cardiovascular events (OR: 0.87, 95% CI 0.81 to 0.94; P<0.01) and a higher risk of major bleeding (OR 1.34, 95% CI 1.14 to 1.57; P<0.01). Overall, we would expect 13 cardiovascular events to be prevented for every 1000 patients treated with the combination, but 6 major bleeds would be caused. In the CURE trial, for every 1000 people treated, 23 events would be avoided and 10 major bleeds would be caused. In the CHARISMA trial, for every 1000 people treated, 5 cardiovascular events would be avoided and 3 major bleeds would be caused.
AUTHORS' CONCLUSIONS: The available evidence demonstrates that the use of clopidogrel plus aspirin is associated with a reduction in the risk of cardiovascular events and an increased risk of bleeding compared with aspirin alone. Only in patients with acute non-ST coronary syndrome benefits outweigh harms.
Alessandro Squizzato; Tymen Keller; Erica Romualdi; Saskia Middeldorp
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2011-01-19
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2011  
Date Detail:
Created Date:  2011-01-20     Completed Date:  2011-02-28     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD005158     Citation Subset:  IM    
Research Center on Thromboembolic Disorders and Antithrombotic Therapies, Department of Clinical Medicine, University of Insubria, Medicina 1, viale Borri, 57, Varese, Italy, 21100.
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MeSH Terms
Aspirin / adverse effects,  therapeutic use*
Cardiovascular Diseases / prevention & control*
Drug Therapy, Combination / adverse effects,  methods
Platelet Aggregation Inhibitors / adverse effects,  therapeutic use*
Randomized Controlled Trials as Topic
Ticlopidine / adverse effects,  analogs & derivatives*,  therapeutic use
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; A74586SNO7/clopidogrel
Update Of:
Cochrane Database Syst Rev. 2007;(3):CD005158   [PMID:  17636787 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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