Clopidogrel Plus Aspirin Versus Aspirin Alone for Preventing Cardiovascular Disease in Acute Non-ST Segment Coronary Syndromes
The long-term use of clopidogrel plus aspirin reduces cardiovascular events compared with aspirin alone in patients with acute non-ST coronary syndrome. Level of evidence: "A"The CURE trial 2 (n = 12 562) was included in the Cochrane review [Abstract] 1. A loading clopidogrel dose, 300 mg orally, followed by 75 mg daily (mean duration of treatment, 9 months) confined to people with acute non-ST segment coronary syndromes, showed definite evidence of benefit from treatment (all cardiovascular events: OR 0.84, 95% CI 0.77 to 0.93) and an increase in major bleeding (OR 1.39, 95% CI 1.14 to 1.70). The observed decrease in death from cardiovascular causes was non-significant (OR 0.93, 95% CI 0.79 to 1.08). For every 1000 people treated for an average of 9 months, 23 events would be avoided and 10 major bleeds would be caused.
References
- Squizzato A, Keller T, Romualdi E, Middeldorp S. Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease. Cochrane Database Syst Rev 2011;(1):CD005158. [PubMed].
- Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK, Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001 Aug 16;345(7):494-502. [PubMed]