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Patients at High Risk for Cardiovascular Disease Benefit With Dual Antiplatelet Therapy: Presented at ACC By Bruce Sylvester ATLANTA -- March 17, 2010 -- Among patients with acute coronary syndrome (ACS) and non-ACS patients, all with established and high-risk cardiovascular (CV) disease, combination treatment with clopidogrel and aspirin significantly reduces both composite and individual adverse CV outcomes. Researchers reported the findings here on March 15 during a poster presentation at the 59th Annual Scientific Sessions of the American College of Cardiology (ACC). “The use of clopidogrel and aspirin in dual antiplatelet therapy in patients with established vascular disease -- both acute coronary syndrome and nonacute coronary syndrome -- decreases cardiovascular death, MI [myocardial infarction], and stroke, though it can increase the risk of major bleeding,” said presenter and lead investigator Swapna Kamireddy, MD, University of Buffalo School of Medicine, Buffalo, New York. Through a Medline and Cochrane search, the investigators identified 5 eligible trials for their study, which included 76,174 patients with established vascular disease. The criteria for trial inclusion in the meta-analysis were (1) studies that compared clopidogrel and aspirin with aspirin and placebo; (2) studies that included high-risk populations such as those with unstable angina, non-ST segment elevation MI, ST segment elevation MI, patients undergoing percutaneous coronary intervention (PCI), or those with established CV disease; (3) studies that measured CV events such as death, MI, and stroke; and (4) studies that documented safety outcomes such as major bleeding. The primary endpoint of the study was the composite outcome of CV mortality, MI, and stroke. The investigators also assessed data for individual outcomes of all-cause mortality, CV mortality, MI, and stroke, as well as major bleeding as a safety outcome. They reported that for dual therapy versus aspirin monotherapy, there was a significant 15% reduction in the odds ratio (OR) for the primary composite outcome (OR = 0.85; P < .0001), signifying a 7% decrease in all-cause mortality (OR = 0.93; P = .009), and a 7% decrease for CV mortality (OR = 0.93; P = .01). For MI, the OR was reduced significantly by 18% (OR = 0.82; P < .00001), and for stroke the OR was reduced significantly by 16% (OR = 0.84; P = .005). However, dual antiplatelet therapy also significantly increased the odds of major bleeding by 17% (OR = 1.17; P = .02). Dr. Kamireddy commented, “Clinically there is a trade-off in dual antiplatelet therapy, but in these patients who are at high-risk of MI and other adverse cardiovascular outcomes, it can be worth it. Major bleeding can be tackled effectively by various means with these patients, and the value of dual therapy for these patients is validated here.” [Presentation title: Clopidogrel and Aspirin Versus Aspirin Alone in High-Risk Patients With Established Vascular Disease: A Meta-Analysis of Randomized Controlled Trials. Abstract 1107-319] E-mail this page to a friend or colleague! To print, use this version