Researchers conducted a systematic review and individual patient meta-analysis of seven randomized trials comparing clopidogrel monotherapy with aspirin for secondary prevention in 28,982 patients with coronary artery disease (CAD) from Asia (66.8 per cent), Europe (17.4 per cent), and North America (15.8 per cent).
The participants had a median age of 65.5 years, 21.4 per cent were women, and around half had a prior myocardial infarction (MI), while almost a third (30.6 per cent) had Diabetes. Acute coronary syndrome was the main cause of CAD, at a rate of 68.4 per cent, and 71.0 per cent of patients had previously undergone coronary intervention.
Over a maximum follow-up of 5.5 years (median 2.3 years), there were 1,991 incidences of major adverse cardiovascular
or cerebrovascular (MACCE), a composite of cardiovascular death, MI, or stroke. The rates were 10.6 per cent among patients taking clopidogrel and
12.7 per cent among those taking aspirin, translating to a “highly significant” 14 per cent risk reduction.
Looking at the individual components of the MACCE endpoint, the researchers found that the benefit with clopidogrel was driven primarily by significant reductions in MI and stroke. There was also a significant reduction in
ischemic stroke with clopidogrel versus aspirin, but not for hemorrhagic stroke or cardiovascular death.
This meant that there was a significant 11 per cent risk reduction in the incidence of net adverse cardiac or cerebrovascular events with clopidogrel compared with aspirin, occurring in 12.9 per cent versus
15.3 per cent of patients.
These findings support the consideration of the P2Y12 inhibitor clopidogrel which may be a better antiplatelet option than aspirin for preventing major adverse cardiovascular or cerebrovascular (MACCE) events in patients with established coronary artery disease (CAD)
Source: The Lancet, 2025
