Clopidogrel Monotherapy versus Aspirin Monotherapy in Patients with Established Cardiovascular Disease: Systematic Review and Meta-Analysis

Abstract

Background: The is no clear consensus on whether Aspirin offers better outcomes in terms of secondary cardiovascular disease prevention compared to Clopidogrel. Objective: The aim of the study was to compare the safety and efficacy of Clopidogrel versus Aspirin in patients with established cardiovascular disease. Patients/Methods: A systematic review of MEDLINE (via PubMed), Scopus, and Cochrane Library databases (last search date: August 28th, 2021) was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement for randomized control trials (RCTs) of Clopidogrel versus Aspirin as monotherapy in patients with established cardiovascular disease. Random-effects meta-analyses were performed. Results: Five RCTs incorporating 26,855 patients (Clopidogrel: 13,426; Aspirin: 13,429) were included. No statistically significant difference was observed between Clopidogrel and Aspirin in terms of all-cause mortality (odds ratio [OR]: 1.01 [95% Confidence Interval (95%CI):0.91-1.13]; p=0.83), ischemic stroke (OR: 0.87 [95%CI:0.71-1.06]; p=0.16) and major bleeding rates (OR: 0.77 [95%CI:0.56-1.06]; p=0.11). Patients receiving Clopidogrel had borderline lower risk for major adverse cardiovascular events (MACE) (OR: 0.84 [95%CI:0.71-1.00]; p=0.05) and lower risk for non-fatal myocardial infarction (OR: 0.83 [95%CI:0.71-0.97]; p=0.02, relative-risk-reduction=16.9%, absolute-risk-reduction=0.5%, number-needed-to-treat=217 for a mean period of 20 months) compared to patients receiving Aspirin. Conclusions: In patients with established cardiovascular disease, Clopidogrel was associated with a 17% relative-risk reduction for non-fatal MI, borderline decreased risk for MACE and similar risk for all-cause mortality, stroke and major bleeding compared to Aspirin. Keywords: Clopidogrel; Aspirin; monotherapy; cardiovascular disease; efficacy; myocardial infarction; stroke; mortality; safety; major bleeding

Effects of antiplatelet therapy on menstrual blood loss in reproductive-aged women: a systematic review

“…These findings may, therefore, not be generalizable to the population of reproductive-aged women. Both clopidogrel as well as aspirin monotherapy for secondary prevention of cardiovascular disease have been associated with similar odds of major bleeding [ 45 ]. However, these studies have been conducted in cohorts that primarily consisted of males (only 26% women) with a higher average age (62.7 ±11 years).…”

Evolving Strategies for Use of Phytochemicals in Prevention and Long-Term Management of Cardiovascular Diseases (CVD)

“…This compound, formed by the esterification of salacylic acid to acetylsalicylic acid (ASA), is a naturally occurring component of willow bark which has extensive historical use by humans as an analgesic in the form of bark extracts and tinctures—and is currently marketed without requirement for medical prescription in purified form as a nonsteroidal anti-inflammatory drug (NSAID) used to suppress fever, pain, and other inflammation-associated aspects of a wide range of illness and trauma—with corollary use as an antithrombitic [ 109 , 110 ]. There is also some evidence for the value of this agent in decreasing the risk of ischemic stroke and secondary heart attack in susceptible individuals [ 111 , 112 ]; nevertheless, support for use of regular aspirin intake as general prophylaxis against CVD is substantially anecdotal at the time of this writing [ 113 , 114 ].…”