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In the August issue of Prescrire International:
Clopidogrel in addition to aspirin

FREE DOWNLOAD In myocardial infarction not treated with angioplasty, the addition of clopidogrel to aspirin seems to benefit some patients. Unfortunately, no evidence is available beyond 4 weeks indicating a better risk-benefit balance for aspirin plus clopidogrel as compared to aspirin alone.
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Abstract

  • In patients with myocardial infarction who are not eligible for angioplasty, adding clopidogrel to aspirin reduces the overall 15-day mortality rate, but the subsequent outcome is not known.
  • Previously approved in combination with aspirin for the treatment of acute coronary syndromes without ST depression, clopidogrel (Plavix°, Sanofi Pharma, Bristol-Myers Squibb), is now also approved for myocardial infarction with ST elevation.
  • In practice, in myocardial infarction not treated with coronary angioplasty, the addition of clopidogrel to aspirin seems to benefit some patients (about 1 in 200). This combination may therefore be used in the short term (4 weeks). However, no evidence is available beyond 4 weeks indicating a better risk-benefit balance for aspirin plus clopidogrel as compared to aspirin alone.
  • The COMMIT study, designed to compare a combination of clopidogrel and aspirin with aspirin alone in patients with ST elevation myocardial infarction , mobilised tens of thousands of people.
  • What a shame! All this trial showed is that, compared with aspirin alone, the clopidogrel-aspirin combination significantly reduces overall mortality… during the next 15 days. What a shame that the investigators did not evaluate effects on overall mortality for at least a few months after the myocardial infarction. So much time, energy and money invested, so little information in return.

    ©Prescrire August 2007

    Source: Prescrire International 2007; 16 (90): 146.

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