Media release

From: The Lancet

The Lancet: Clopidogrel more effective than aspirin for long-term heart disease prevention without added bleeding risk, new study finds

A comprehensive analysis of nearly 29,000 patients with coronary artery disease (CAD) suggests that clopidogrel, a commonly prescribed blood thinner, is more effective than aspirin in preventing serious heart and stroke events, without increasing the risk of major bleeding. The new study, published The Lancet, challenges the long-standing recommendation of aspirin as the default treatment for secondary prevention in CAD patients.

CAD, a condition characterized by narrowed heart arteries, often requires lifelong treatment to prevent heart attacks, strokes, and cardiovascular death. Aspirin has traditionally been prescribed indefinitely for patients with CAD. However, the evidence supporting aspirin’s long-term benefits and safety has been limited. This new analysis of seven clinical trials found that patients taking clopidogrel had a 14% lower risk of major adverse cardiovascular or cerebrovascular events (including heart attack, stroke, or cardiovascular death) compared to those taking aspirin. Importantly, the rates of major bleeding were similar between the two drugs, dispelling concerns that clopidogrel might lead to more bleeding complications.

The analysis drew from diverse patient groups, including those who had undergone procedures like stent placement or had experienced acute coronary syndrome, and examined various subgroups to ensure the findings applied broadly. Notably, even patients who might respond less well to clopidogrel due to genetic or clinical factors still benefited from its use over aspirin. These results suggest that clopidogrel should be considered the preferred long-term antiplatelet medication for patients with established coronary artery disease.

The authors say that because both medications are widely available, the study’s findings have the potential to influence clinical guidelines worldwide and improve patient outcomes. Further research on the cost-effectiveness of clopidogrel, as well as broader population studies, is needed to support changes in treatment standards.