CAPRIE trial

The CAPRIE trial found that compared to aspirin (325 mg daily), clopidogrel (75 mg daily) was associated with RRR of 8.7% p = 0.043) for the composite endpoint of ischemic stroke, Ml, or vascular death among 19,185 subjects with stroke, MI, or peripheral arterial disease, but no significant reduction in the composite endpoint in the subgroup with stroke (RRR 7.3%, p = 0.26). No comparison of clopidogrel with aspirin in the acute stroke period was performed. Furthermore, stroke as an endoint was not significantly reduced in the stroke patients entered in this trial (RRR 8.0%, p = NS). 

The results obtained in the CAPRIE trial showing that clopidogrel was superior to aspirin, particularly in high-risk patients, led researchers to consider whether addition of aspirin to... 

In the CAPRIE trial (Clopidogrel vs. Aspirin in Patients at Risk of Ischemic Events), clopidogrel reduced the risk of Ml, stroke, or vascular death by 23.8% compared with aspirin in patients with PAD (48). Although this is an impressive reduction in major events, the benefits of clopidogrel over aspirin were identified as a subgroup analysis rather than a primary endpoint. 

The efficacy of clopidogrel as an antiplatelet agent in atherothrombotic disorders was demonstrated in the CAPRIE trial. In this study of more than 19,000 patients with a history of either myocardial infarction (MI), stroke, or peripheral arterial disease (PAD), clopidogrel 75 mg/day was compared with aspirin 325 mg/day for its ability to decrease MI, stroke, or cardiovascular death. In the final analysis, clopidogrel was slightly (8% relative risk reduction [RRR]) more effective than aspirin (p =. 043) and had a similar incidence of adverse effects. It is not associated with the blood dyscrasias (neutropenia) common with its congener, ticlopidine, and is used widely in patients with atherosclerosis. 

Morais J, on behalf of die CAPRIE investigators. Use of concomitant medications in the CAPRIE trial clopidogrel is unlikely to be associated with clinically significant drug interactions. Eur Heart J 99%) 19 (Absttact Suppl) 5. 

The CAPRIE trial (68) clopidogrel vs aspirin in patients at risk of ischemic events compared the efficacy of clopidogrel (plavix) to aspirin in more than 19,000patients with atherosclerosis manifested as ischemic stroke, MI, or LEAD defined by an ABI of 0.85 or less, history of revascularization or amputation secondary to ischemia. In the CAPRIE trial, there were more than 6400 patients with LEAD. Clopidogrel was associated with an overall relative risk reduction of 8.7% for adverse cardiovascular events. Patients with LEAD received the greatest benefit, with a relative risk reduction of 23.8% compared to aspirin alone (68). 

A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996 348(9038) 1329-1339. 

Plavix Two trials were carried out to determine efficacy the CAPRIE and CURE studies. 

CAPRIE was a 19,185-patient, 304-center, international, randomized, double-blind, parallel-group trial comparing Plavix (75mg daily) with aspirin (325mg daily). The outcome was to compare the first occurrence of new ischemic stroke, new myocardial infarction, or other vascular death. The following are tabulated results ... 

In addition to the risk of bleeding, which will be detailed in the different studies, thienopyridines are able to cause skin disorders (rashes or prurit) and gastrointestinal disorders (diarrhea). In the CLASSICS study, these side effects were observed in 8.2% of patients treated with ticlopidine and in 3.5% of those taking clopidogrel treatment. The most serious problem was related to hematologic disorders neutropenia or thrombocytopenia. These disorders are much less frequent with clopidogrel than with ticlopidine 0.04% of neutropenia in the CAPRIE study and 0.05% in the CURE trial, Thrombotic thrombocytopenic purpura are exceptional one for 200,000 patients. 

Antiplatelet therapy reduces the risk of recurrent vascular events after TIA and ischemic stroke, although few trials have distinguished between different etiological subtypes (Antithrombotic Trialists Collaboration 2002). Most trial data concern aspirin, but other antiplatelet agents such as clopidogrel (CAPRIE Steering Committee 1996) or extended-release dipyridamole (Sivenius et al. 1991) have also been shown to be effective although mechanisms of action may differ (Table 24.2). 

A randomized trial of aspirin and sulfinpyrazone in threatened stroke. New England Journal of Medicine 299 53-59 CAPRIE Steering Committee (1996). 

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