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

Abstract

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. (ClinicalTrials.gov number, NCT00050817.).

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

“…The combination of clopidogrel and aspirin did not reduce stroke risk compared with either treatment alone in the MATCH (Management of Atherothrombosis with Clopidogrel in High-Risk Patients) and CHA-RISMA (Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance) trials 27,61 ; however, in ESPS-2 (Second European Stroke Prevention Study), the combination of aspirin plus dipyridamole was superior to aspirin alone in patients with prior TIA or stroke. 28 Outcomes in a subgroup defined on the basis of ECVD were not reported.…”

Antiplatelet Therapy in Cerebrovascular Disease: Implications of MATCH and CHARISMA Results for Cardiologists

“…Of the patients with established cardiovascular disease (n = 12,153), 4,320 (35%) had a TIA or ischemic stroke during the 5 years prior to study entry. 6 Among all patients enrolled in CHARISMA, there was no statistically significant difference between treatment groups in the rates of occurrence of the primary efficacy endpoint (clopidogrel plus aspirin 6.8%, aspirin alone 7.3%; RR 0.93, 95% CI 0.83-1.05; p = 0.22) ( Table 3). Patients with multiple risk factors but no clearly established vascular disease (primary prevention cohort) did not benefit from the addition of clopidogrel to aspirin; instead, adjunctive clopidogrel was associated with a nonsignificant 20% relative increase in the rate of primary events, as well as an excess in cardiovascular mortality (3.9 versus 2.2%, p = 0.01).…”

“…The MATCH trial examined the efficacy and safety of the antiplatelet clopidogrel used alone or with aspirin for secondary stroke prevention in high-risk patients; 5 CHARISMA evaluated the efficacy and safety of the combination compared with aspirin alone in patients with clinically evident cardiovascular disease or multiple risk factors. 6 In an effort to put the results of these studies in context, this article also includes the following:…”

Worth an Arm and a Leg: The Critical Importance of Limb Ischemia

“…First, CLI requires a multidisciplinary assessment and treatment plan, including medical management of the overall atherosclerotic disease burden, ancillary services focused on wound care, and a focused assessment on the options for endovascular or surgical revascularization. Medical therapy, including antiplatelet agents, angiotensin‐converting enzyme inhibitors, and statins, has been demonstrated to reduce adverse events in this vulnerable population 9, 10, 11, 12, 13. Because of this, professional society guidelines have endorsed the use of these agents for all patients with peripheral artery disease and CLI 14, 15.…”