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Related Experiment Videos

Clopidogrel for cerebrovascular prevention.

M Paciaroni1, J Bogousslavsky

  • 1Service de Neurologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Cerebrovascular Diseases (Basel, Switzerland)
|September 4, 1999
PubMed
Summary

Clopidogrel demonstrated an 8.7% reduction in vascular events compared to aspirin in high-risk patients. While effective, clopidogrel

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Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Neurology

Background:

  • Atherothrombosis underlies ischemic stroke, myocardial infarction, and peripheral arterial disease.
  • Antiplatelet agents like aspirin and ticlopidine are used for secondary prevention of vascular events.
  • Newer antiplatelet agents are needed due to potential adverse effects of existing therapies.

Purpose of the Study:

  • To compare the efficacy and safety of clopidogrel versus aspirin in patients at risk of ischemic events.
  • To evaluate clopidogrel's effectiveness in reducing the composite outcome of ischemic stroke, myocardial infarction, or vascular death.

Main Methods:

  • The Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial was a randomized, blinded, international study.
  • 19,185 patients were enrolled in an intention-to-treat analysis.
  • Compared the incidence of ischemic stroke, myocardial infarction, or vascular death between clopidogrel and aspirin groups.

Main Results:

  • Clopidogrel showed an 8.7% relative risk reduction in the composite outcome compared to aspirin (p = 0.043).
  • Annual event rates were 5.33% for clopidogrel and 5.83% for aspirin.
  • Adverse events were generally higher with aspirin, except for rash, diarrhea, and abnormal liver function.

Conclusions:

  • Clopidogrel offers comparable efficacy to aspirin with a potentially better safety profile, suggesting it may replace ticlopidine for stroke prevention.
  • Clopidogrel's higher cost and less widespread experience may limit its adoption over aspirin as first-line therapy for some clinicians.
  • The CAPRIE study demonstrated a significant advantage for clopidogrel over aspirin, leading some clinicians to prefer it as a first-choice treatment.

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