Clopidogrel in ischemic heart disease: A critical appraisal

Aspirin and clopidogrel are the commonest dual antiplatelet agents being used in the secondary prevention of cardiovascular disease. In high risk patients with coronary heart disease, the use of aspirin was associated with a significant risk reduction of myocardial infarction, stroke and vascular death. The use of clopidogrel alone was slightly superior to aspirin, and associated with reduced risk of vascular death, ischemic stroke and myocardial infarction. Dual antiplatelet therapy has been well studied in patients with acute coronary syndrome and those undergoing percutaneous coronary intervention (PCI). In patients with stable coronary heart disease or multiple risk factors the combination of clopidogrel plus aspirin was not significantly more effective than aspirin alone in reducing MI, stroke or death from cardiovascular causes.