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Patients with prior myocardial infarction, stroke, or symptomatic peripheral arterial disease in the CHARISMA trial

Deepak L Bhatt1, Marcus D Flather, Werner Hacke

  • 1Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA. bhattd@ccf.org

Journal of the American College of Cardiology
|May 15, 2007
PubMed

Insights

Dual antiplatelet therapy with clopidogrel plus aspirin significantly reduced cardiovascular events in patients with prior myocardial infarction, stroke, or PAD. This combination therapy may offer benefits beyond aspirin alone for high-risk individuals.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Clinical Trials

Background:

  • Dual antiplatelet therapy (clopidogrel plus aspirin) is established for acute coronary syndromes and stenting.
  • The CHARISMA trial previously showed no overall benefit in stable patients.

Purpose of the Study:

  • To evaluate the efficacy of dual antiplatelet therapy in a specific high-risk subgroup.
  • To determine the benefit in patients with prior myocardial infarction (MI), ischemic stroke, or symptomatic peripheral arterial disease (PAD).

Main Methods:

  • Subgroup analysis of the CHARISMA trial.
  • Inclusion criteria: documented prior MI, ischemic stroke, or symptomatic PAD.
  • Follow-up duration: median 27.6 months.

Main Results:

  • Dual antiplatelet therapy significantly lowered the rate of cardiovascular death, MI, or stroke (7.3% vs. 8.8%).
  • Hospitalizations for ischemia were also significantly reduced (11.4% vs. 13.2%).
  • Moderate bleeding risk increased significantly, while severe bleeding risk showed no significant difference.

Conclusions:

  • Patients with prior MI, stroke, or symptomatic PAD may benefit from dual antiplatelet therapy (clopidogrel plus aspirin).
  • This suggests a potential role for intensified antithrombotic therapy beyond aspirin alone in this population.
  • Future trials are needed to validate these findings.
Abstract

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