Clopidogrel Aspirin

The third trial was a subgroup analysis of the CLARITY (29) trial performed in acute Ml. It was demonstrated that in STEM I patients, treated with fibrinolytic and who underwent PCI during the hospitalization period (n = 1863 patients), the dual antiplatelet treatment was able to reduce major vascular events (death, Ml, and stroke) from 12% to 7.5% (RRR = 0.59 95% Cl 0.43-0.81 P = 0.001). Thus, the treatment with clopidogrel + aspirin of 43 STEMI patients followed by PCI prevents one major vascular event. 

The study design included three comparisons ACTIVE W ACTIVE A, and ACTIVE I in 14,000 patients, (Maximum follow-up was for 48 months), The primary endpoint was the time to first vascular event (stroke, Ml, vascular death, systemic emboli). ACTIVE W arm was halted when 6600 patients were enrolled because there a clear benefit from warfarin treatment compared to clopidogrel + aspirin 3.63% of vascular events versus 5,64% (P = 0,0002). Subgroup analysis showed that these disappointing results were observed in patients on warfarin prior to study (HR = 1.5, P = 0.0006), but there was no difference between the two strategies—when the patients were not on warfarin prior to study (HR = 1.32, P = 0,17), Nevertheless, further results are awaited from the ACTIVE-A arm (ASA or ASA + clopidogrel) in patients who cannot or would not take OAC. 

Bertrand ME, Rupprecht HJ, Urban R Gershlick AH, Investigators FT, Double-blind study ofthe safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting the clopidogrel aspirin stent international cooperative study (CLASSICS). Circulation 2000 102 624-629,... 

Fisher LD, Gent M, Buller HR (2001) Active-control trials how wonld a new agent compare with placebo A method iUnstrated clopidogrel, aspirin, and placebo. American Heart Journal 141 26-32. 

Cattaneo M (2004) Aspirin and clopidogrel efficacy, safety, and the issue of drag resistance. Arterioscler Thromb Vase Biol 24 1980-1987... 

PROFESS is an ongoing large randomized trial examining combination ER-DP plus aspirin therapy compared with clopidogrel (each group also with or without telmisartan, an angiotensin receptor antagonist) for the secondary prevention of early and late recurrent stroke, and other vascular events. 

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). 

Subgroup analyses of the MATCH data suggested a 12% risk reduction in recurrent vascular events at 18 months in patients with large vessel disease who were given combination aspirin and clopidogrel compared with clopidogrel alone. 

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. 

Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ MATCH investigators. Aspirin and clopidogrel compared with clopidogrel alone after recent ischemic stroke or transient ischemic attack in high-risk patients (MATCH) randomised, double-blind, placebo-controlled trial. Lancet 2004 364(9431) 331-337. 

Markus HS, Droste DW, Kaps M, Larrue V, Lees KR, Siebler M, Ringelstein EB. Dual antiplatelet therapy with clopidogrel and aspirin in s3miptomatic carotid stenosis evaluated using doppler embolic signal detection the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 2005 lll(17) 2233-2240. 

Antiplatelet therapy with aspirin should be considered for all patients without contraindications, particularly in patients with a history of myocardial infarction. Clopidogrel may be considered in patients with allergies or intolerance to aspirin. In some patients, combination antiplatelet therapy with aspirin and clopidogrel may be used. 

Recent studies have suggested that combination antiplatelet therapy may be synergistic in reducing the risk of IHD-related events. In patients with ACS, the combination of aspirin and clopidogrel 75 mg daily for up to 9 months was more effective than aspirin alone in decreasing the risk of... 

For patients with NSTE ACS, clopidogrel started on the first day of hospitalization as a 300 to 600 mg loading dose and followed the next day by 75 mg orally per day is recommended for most patients.2 Although the use of aspirin in ACS is the mainstay of antiplatelet therapy, morbidity and mortality following an ACS remain high. Clopidogrel, administered as a 300 mg loading dose followed by 75 mg once daily for 9 to... 

Aspirin decreases the risk of death, recurrent infarction, and stroke following myocardial infarction. Aspirin prescription at hospital discharge is a quality care indicator in MI patients.3 All patients should receive aspirin indefinitely those patients with a contraindication to aspirin should receive clopidogrel.2,3... 

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