Clopidogrel versus Aspirin in Patients with Atherothrombosis

Kourlaba, Georgia; Fragoulakis, V.; Maniadakis, Nikos

doi:10.1007/bf03261867

Cited by 11 publications

(6 citation statements)

References 40 publications

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“…A CAPRIE-based cost-effectiveness model for Greece investigating ASA versus clopidogrel in patients with atherosclerosis showed the latter to be cost effective as a secondary prevention of thrombotic events in Greek patients, implying that a single antiplatelet agent would also work well instead of a DAPT regimen [16].…”

Section: Discussionmentioning

confidence: 99%

Aspirin Versus Clopidogrel Monotherapy for the Treatment of Patients with Stable Coronary Artery Disease: A Systematic Review and Meta-Analysis

Ding

2019

Adv Ther

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IntroductionAlthough aspirin (ASA) is the mainstay of treatment for the prevention of recurrent ischemic stroke, the Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial showed ASA monotherapy to be inferior to clopidogrel in preventing recurrent adverse cardiovascular outcomes in patients with high cardiac risks. Here, we aimed to systematically compare ASA versus clopidogrel monotherapy for the treatment of patients with stable coronary artery disease (CAD).MethodsElectronic databases were searched and studies were included if they compared ASA versus clopidogrel monotherapy for the treatment of patients with CAD and they reported adverse clinical outcomes. The latest version of RevMan software (version 5.3) was used as the statistical tool for the data analysis. Odds ratios (OR) and 95% confidence intervals (CI) were generated to interpret the data.ResultsA total number of 5497 patients (from years 2003 to 2011) were treated with ASA monotherapy, whereas 2544 patients were treated with clopidogrel monotherapy. Results of this analysis showed no significant difference in composite endpoints (cardiovascular death, myocardial infarction, and stroke) (OR 0.99, 95% CI 0.47–2.10; P = 0.98), all-cause mortality (OR 1.05, 95% CI 0.82–1.33; P = 0.71), cardiac death (OR 0.89, 95% CI 0.17–4.74; P = 0.89, myocardial infarction (OR 0.84, 95% CI 0.52–1.36; P = 0.48), stroke (OR 1.26, 95% CI 0.39–4.06; P = 0.70), and bleeding defined by the Bleeding Academic Research Consortium (BARC [grade 3 or above]) (OR 1.28, 95% CI 0.78–2.12; P = 0.33).ConclusionThis analysis did not show any significant difference in all-cause mortality, cardiac death, myocardial infarction, stroke, and BARC grade 3 or above among CAD patients who were treated with either ASA or clopidogrel monotherapy. However, as a result of the limited data, this hypothesis should be confirmed in other major trials.

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Section: Discussionmentioning

confidence: 99%

Aspirin Versus Clopidogrel Monotherapy for the Treatment of Patients with Stable Coronary Artery Disease: A Systematic Review and Meta-Analysis

Ding

2019

Adv Ther

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“…It might be used as a monotherapy as a a reasonable and equivalent option to aspirin in nonembolic ischemic stroke patients or in combination with aspirin for 21 days of dual antiplatelet therapy following a minor ischemic stroke or transient ischemic attack (TIA) in patients with a higher risk of recurrent stroke. Some relevant papers have demonstrated its efficacy and safety and, in some cases, its advantage over aspirin [2]. However, the inhibition of platelets among different subjects might be limited and variable.…”

Section: Introductionmentioning

confidence: 99%

The Phenomenon of Clopidogrel High On-Treatment Platelet Reactivity in Ischemic Stroke Subjects: A Comprehensive Review

Wiśniewski

Filipska

2020

IJMS

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Clopidogrel is increasingly being used for the secondary prevention of ischemic stroke according to the updated guidelines on acute stroke management. Failure to achieve a drug response is referred to as clopidogrel resistance. Similarly, a higher activation of platelets during clopidogrel therapy—high on-treatment platelet reactivity—is equivalent to a reduced effectiveness of a therapy. Clopidogrel resistance is considered to be a common and multifactorial phenomenon that significantly limits the efficacy of antiplatelet agents. The aim of the current study is to review the latest literature data to identify the prevalance and predictors of clopidogrel high on-treatment platelet reactivity among stroke subjects and to establish the potential impact on clinical outcomes and prognosis. Clinical databases were searched by two independent researchers to select relevant papers on the topic, including all types of articles. Several important predictors contributing to clopidogrel resistance were identified, including genetic polymorphisms, the concomitant use of other drugs, or vascular risk factors, in particular nonsmoking and diabetes. Clopidogrel high on-treatment platelet reactivity has a negative impact on the clinical course of stroke, worsens the early- and long-term prognoses, and increases the risk of recurrent vascular events. Platelet function testing should be considered in selected stroke individuals, especially those predisposed to clopidogrel resistance, for whom an improvement in the efficacy of antiplatelet therapy is essential. This particular group may become the greatest beneficiaries of the modification of existing therapy based on platelet function monitoring.

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“… 5 However, because clopidogrel is more expensive than aspirin, data around the cost-effectiveness of clopidogrel and aspirin after PCI for their lifelong use are important, given the financial pressures being faced by health care systems in various countries. 6 , 7 , 8 , 9 , 10 , 11 We therefore performed a cost-effectiveness analysis of clopidogrel and aspirin monotherapy after PCI based on the results from the HOST-EXAM trial in 3 disparate health care systems.…”

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confidence: 99%

Cost-Effectiveness of Clopidogrel vs Aspirin Monotherapy After Percutaneous Coronary Intervention

et al. 2023

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Clopidogrel versus Aspirin in Patients with Atherothrombosis

Abstract: The analysis indicates that clopidogrel is cost effective for the secondary prevention of atherothrombotic events in the Greek setting. These findings are in line with those reported in other European countries.

Cited by 11 publications

References 40 publications

Aspirin Versus Clopidogrel Monotherapy for the Treatment of Patients with Stable Coronary Artery Disease: A Systematic Review and Meta-Analysis

Aspirin Versus Clopidogrel Monotherapy for the Treatment of Patients with Stable Coronary Artery Disease: A Systematic Review and Meta-Analysis

The Phenomenon of Clopidogrel High On-Treatment Platelet Reactivity in Ischemic Stroke Subjects: A Comprehensive Review

Cost-Effectiveness of Clopidogrel vs Aspirin Monotherapy After Percutaneous Coronary Intervention

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