Aspirin Alone or Clopidogrel and Aspirin for the Prevention of Atherothrombotic Events

Traditionally most patients at high risk of cardiovascular events have been treated with aspirin alone. Recently dual antiplatelet therapy with aspirin and clopidogrel has become more widely prescribed. This study published in NEJm compares both strategies.

15,603 patients with either clinically evident cardiovascular disease or multiple risk factors were randomized to receive clopidogrel (75 mg per day) plus low-dose aspirin (75 to 162 mg per day) or placebo plus low-dose aspirin and followed them for a median of 28 months. The primary efficacy end point was a composite of myocardial infarction, stroke, or death from cardiovascular causes.

In this trial, there was a suggestion of benefit with clopidogrel treatment in patients with symptomatic atherothrombosis and a suggestion of harm in patients with multiple risk factors. Overall, clopidogrel plus aspirin was not significantly more effective than aspirin alone in reducing the rate of myocardial infarction, stroke, or death from cardiovascular causes.

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