Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular events

Squizzato, Alessandro; Bellesini, Marta; Takeda, Andrea; Middeldorp, Saskia; Donadini, Marco Paolo

doi:10.1002/14651858.cd005158.pub4

Cited by 59 publications

(35 citation statements)

References 112 publications

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“…The search yielded 1503 unique studies, from which 28 meta‐analyses were included. Twenty‐one included RCTs alone, and seven also included cohort studies ( Fig . ; Appendix S1 , supporting information).…”

Section: Resultsmentioning

confidence: 99%

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Umbrella review and meta-analysis of antiplatelet therapy for peripheral artery disease

Ambler

Waldron

Contractor

et al. 2020

Journal of British Surgery

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Background: The literature on antiplatelet therapy for peripheral artery disease has historically been summarized inconsistently, leading to conflict between international guidelines. An umbrella review and meta-analysis was performed to summarize the literature, allow assessment of competing safety risks and clinical benefits, and identify weak areas for future research.Methods: MEDLINE, Embase, DARE, PROSPERO and Cochrane databases were searched from inception until January 2019. All meta-analyses of antiplatelet therapy in peripheral artery disease were included. Quality was assessed using AMSTAR scores, and GRADE analysis was used to quantify the strength of evidence. Data were pooled using random-effects models.Results: Twenty-eight meta-analyses were included. Thirty-three clinical outcomes and 41 antiplatelet comparisons in 72 181 patients were analysed. High-quality evidence showed that antiplatelet monotherapy reduced non-fatal strokes (3 (95 per cent c.i. 0 to 6) fewer per 1000 patients), In symptomatic patients, it reduced cardiovascular deaths (8 (0 to 16) fewer per 1000 patients), but increased the risk of major bleeding (7 (3 to 14) more events per 1000). In asymptomatic patients, monotherapy reduced non-fatal strokes (5 (0 to 8) fewer per 1000), but had no other clinical benefit. Dual antiplatelet therapy caused more major bleeding after intervention than monotherapy (37 (8 to 102) more events per 1000), with very low-quality evidence of improved endovascular patency (risk ratio 4⋅00, 95 per cent c.i. 0⋅91 to 17⋅68).Conclusion: Antiplatelet monotherapy has minimal clinical benefit for asymptomatic peripheral artery disease, and limited benefit for symptomatic disease, with a clear risk of major bleeding. There is a lack of evidence to guide antiplatelet prescribing after peripheral endovascular intervention.The AMSTAR (A MeaSurement Tool to Assess systematic Reviews) measurement tool 17,18 was used to assess the quality of included meta-analyses. AMSTAR is a validated

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Section: Resultsmentioning

confidence: 99%

“…The median AMSTAR score was 8 (range 3–11). The higher‐quality meta‐analyses were all published by the Cochrane Collaboration. Thirty‐three unique safety and efficacy outcomes were reanalysed from the 121 included studies.…”

Section: Resultsmentioning

confidence: 99%

Umbrella review and meta-analysis of antiplatelet therapy for peripheral artery disease

Ambler

Waldron

Contractor

et al. 2020

Journal of British Surgery

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“…If the patient is intolerant of aspirin or it is otherwise contraindicated, a P2Y12 receptor inhibitor can be given instead of aspirin, but two different P2Y12 receptor inhibitors should not be given together. P2Y12 receptor inhibitors can reduce mortality and morbidity, but they are associated with an increased risk of bleeding [113,114]. Ticagrelor and prasugrel are newer P2Y12 agents, which trials have shown to have a faster onset of action and greater efficacy compared with Clopidogrel [1,115].…”

Section: Ticagrelormentioning

confidence: 99%

Non-ST Elevation Myocardial Infarction: Diagnosis and Management

Ahmad¹,

Ali²

2019

Myocardial Infarction

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Cardiovascular disease is expected to be the main cause of death globally due to the rapidly increasing prevalence of obesity, hypertension and diabetes mellitus. Atherosclerotic lesions and plaque rupture are the most common cause of myocardial infarction. Resting 12-lead ECG is the first diagnostic test for patients with chest pain and should be performed and interpreted within the first 10 min of the patient's admission to the emergency department. Cardiac biomarkers preferably, high-sensitivity cardiac troponin, is mandatory in all patients with suspected NSTEMI for the diagnosis, risk stratification and treatment. Rapid, efficient diagnosis and risk stratification of patients with chest pain will help to administer the appropriate medication and plan for the timing of invasive strategy and the choice of revascularization. This chapter helps to simply but elaborately discuss the diagnosis, risk stratification and the management of patients with non-ST elevation of myocardial infarction.

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“…1 De duur van de behandeling was ten minste 30 dagen en in 2 onderzoeken langer dan 1 jaar (gemiddeld namelijk 28 maanden en 8,2 jaar). Het relatief risico op het ontwikkelen van een myocardinfarct of ischemisch CVA voor aspirine en clopidogrel versus alleen aspirine was respectievelijk 0,78 (95%-BI 0,69 tot 0,90) en 0,73 (95%-BI 0,59 tot 0,91).…”

Section: De Cochrane-reviewunclassified

Duale plaatjesremming of alleen aspirine voor secundaire cardiovasculaire preventie

Harskamp

Geersing

2018

Huisarts Wet

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Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular events

Abstract: Analysis 1.18. Comparison 1 Clopidogrel (Clo) plus aspirin (ASA) versus aspirin alone, Outcome 18 Sensitivity analysislow risk of bias (RoB): cardiovascular mortality.

Cited by 59 publications

References 112 publications

Umbrella review and meta-analysis of antiplatelet therapy for peripheral artery disease

Umbrella review and meta-analysis of antiplatelet therapy for peripheral artery disease

Non-ST Elevation Myocardial Infarction: Diagnosis and Management

Duale plaatjesremming of alleen aspirine voor secundaire cardiovasculaire preventie

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