A new, pioneering study has just dropped some optimistic news. Clopidogrel, a drug used to prevent repeat heart attacks and strokes, turns out to be much better than aspirin for patients with coronary artery disease (CAD). Researchers found that clopidogrel lowers the risk of first major adverse cardiovascular or cerebrovascular events by 14%. This makes clopidogrel a better choice than the long-advocated aspirin. If confirmed in the ongoing Phase 3 CLARITY trial, this finding would change the treatment landscape for millions of people at risk for life-threatening cardiac events.
An independent, international group of medical experts from the United States, United Kingdom, Australia, Switzerland, and Japan performed an in-depth analysis. They analyzed results from seven clinical trials encompassing almost 29,000 patients with CAD. For nearly a century now, aspirin has been the treatment most commonly prescribed by doctors to aid in lowering the chances of such occurrences. The study’s findings call into question this decades-long recommendation. They could lead to a movement away from clopidogrel as the drug of choice for most patients.
In the UK, around 2.3 million people are currently living with CAD. It’s a debilitating condition affecting more than 300 million people around the world. Aspirin is a mild blood thinner that prevents heart attacks and strokes by making blood less sticky. Times have changed, and recent findings point toward clopidogrel as the stronger option. This is huge news, especially as it does not raise the risk of serious bleeding problems—a worry that’s always haunted antiplatelet drugs.
The study team published their findings in “The Lancet,” highlighting that clopidogrel monotherapy offers superior protection against major cardiovascular and cerebrovascular events without an excess risk of bleeding.
“This comprehensive synthesis of available evidence indicates that, in patients with CAD, long-term clopidogrel monotherapy offers superior protection against major cardiovascular and cerebrovascular events compared with aspirin, without an excess risk of bleeding.” – The study team (writing in The Lancet)
As the study authors pointed out, “If clopidogrel is more efficacious than aspirin…” This main finding was consistent even across key subgroups, including in patients with clinical characteristics predictive of a lower response to clopidogrel. This consistency further bolsters the applicability of these findings to a wide array of patients with CAD.
According to British Heart Foundation chief scientific and medical officer professor Bryan Williams, findings like those of this study are crucial. He is confident that it will spur widespread adoption of clopidogrel in clinical practice across the world. This move has the potential to dramatically alter the landscape of treatment protocols. Millions of Americans rely on aspirin as their primary form of protection from cardiovascular events.
Despite these challenges, the results from this groundbreaking analysis present an important opportunity to engage in an ongoing dialogue regarding the best long-term treatment approach for CAD patients. Thousands of people have been taking aspirin because of older studies showing it works to reduce cardiovascular risks. This new evidence should encourage healthcare providers to reconsider these recommendations and change them. They need to do a better job of switching patients over to clopidogrel to increase their odds of avoiding debilitating heart problems.
One of the most important concerns with clopidogrel and aspirin is the occurrence of major bleeding complications. Both drugs fell in the same range in the study. Yet clopidogrel’s effectiveness at preventing adverse cardiovascular events renders it a particularly attractive substitute.