Clopidogrel vs aspirin in patients with established cardiovascular disease: Systematic review and meta-analysis
This systematic review and meta-analysis of 05 RCTs* compared clopidogrel monotherapy with aspirin monotherapy in patients with established CVD.
Clopidogrel monotherapy vs aspirin monotherapy was associated with:
- 17% relative risk reduction for nonfatal MI (P = 0.02).
- Marginally decreased risk for MACE (P = 0.05).
- Similar risks for ACM, ischemic stroke, and major bleeding events.
|Clopidogrel monotherapy provides better or at least similar benefits in patients with established CVD vs aspirin monotherapy.|
Overall, study findings might contribute toward future clinical practice recommendations for the choice of antiplatelet drugs in patients with established CVD.
WHY THIS MATTERS
Aspirin is recommended for secondary prevention of CVD, while clopidogrel is only used in cases of aspirin resistance.
|This systematic review compared clopidogrel monotherapy vs aspirin monotherapy to provide the best currently available evidence† in patients with established CVD.|
This systematic review and meta-analysis (CRD42021283866) was performed by applying
PICO strategy to define search question.
- Peer-reviewed RCTs
- Articles published in English
- Articles comparing aspirin with clopidogrel monotherapies
- Studies in non-English language
- Observational studies
- Studies on aspirin + dipyridamole combinations
- Systematic reviews
- Letters to the editor
- Case series or case reports
|INTERVENTION ARM: Clopidogrel monotherapy.|
|COMPARATOR ARM: Aspirin monotherapy.|
Overall, 05 RCTs (26,855 adult patients) were eligible for the analysis.
|CLOPIDOGREL ARM||ASPIRIN ARM|
|MEAN AGE||62.7 years|
|MEAN FOLLOW-UP||19.9 months|
|NUMBER OF PATIENTS||13,426||13,429|
|Outcome||Studies reported (Total number of patients)||Patients in clopidogrel arm||Patients in aspirin arm||OR (95% CI)||P-value||I2|
|ACM||5 (26,855)||717||708||1.01 (0.91–1.13)||0.83||0.00%|
|IS||4 (26,671)||546||0.87 (0.71–1.06)||0.87 (0.71–1.06)||0.16||11.13%|
|Nonfatal MI*||5 (26,855)||305||367||0.83 (0.71–0.97)||0.02||0.00%|
|MACE||5 (26,855)||1,330||1,267||0.84 (0.71–1.00)||0.05||36.49%|
|Major bleeding events||4 (26,667)||181||223||0.77 (0.56–1.06)||0.11||34.77%|
|*RRR: 16.9%; ARR: 0.5%; NNT: 217 for a mean period of 20 months|
CUMULATIVE STUDY RESULTS COMPARED WITH INDIVIDUAL STUDIES
Results were consistent for mortality, stroke and major bleeding events
No difference found for nonfatal MI
Results from individual studies varied considerably for nonfatal MI for MACE
For information on sensitivity analysis, please click on the hyperlink.
For additional details, please refer the source publication Tasoudis PT, et al.
* Studies included in the analysis: CADET, WATCH, ASCET, CAPRIE and HOST-EXAM
† In Terms of efficacy and safety
‡ Defined differently between the studies.
ACM; all-cause-mortality; ARR, absolute risk reduction; CI, confidence interval; CVD, cardiovascular disease; I2, heterogeneity; IS, ischemic stroke; MACE, major adverse cardiovascular events; MI, myocardial infraction; NNT, number needed to treat; OR, odds ratio; PICO, patient intervention control outcome; RCT, randomized controlled trial; RRR, relative risk reduction.
Disclaimer: The images depicted here are fictitious and meant for illustrative purpose only. Any resemblance to any person, living or dead is purely coincidental.
Tasoudis PT, Kyriakoulis IG, Sagris D, Diener HC, and Ntaios G. Clopidogrel monotherapy versus aspirin monotherapy in patients with established cardiovascular disease: Systematic review and meta-analysis. Thromb Haemost. 2022;122(11):1879-1887. doi: 10.1055/a-1853-2952. PMID: 35577054.