Recommendation ID
CG172/1
Question
In people who have not undergone revascularisation after an MI, does clopidogrel and placebo have a better outcome than clopidogrel and aspirin?
Any explanatory notes
(if applicable)
Why this is important:- Standard antiplatelet therapy after an MI consists of dual therapy (DAPT) with aspirin and clopidogrel, which produces better outcomes than aspirin alone. Research has demonstrated that new P2Y12 inhibitors improve on the outcomes with clopidogrel, when combined with aspirin, although bleeding and subsequently risk are increased. Few studies have used P2Y12 inhibitors without aspirin. There are theoretical reasons why aspirin may detract from the vascular benefits of strong P2Y12 inhibitors. In addition, because clopidogrel alone produces at least the benefit of aspirin alone, it is possible that the supposed benefit of the combination of clopidogrel and aspirin over aspirin alone is due solely to the action of clopidogrel. Limited data on the use of clopidogrel alone in people with vascular diseases suggests the possibility that the addition of aspirin to clopidogrel gives little or no reduction in vascular event rate, at the cost of an increased risk of bleeding. A study of clopidogrel alone compared with clopidogrel and aspirin in people after MI would be valuable because of the potential preserved benefit and reduced risk of bleeding. This might lead to new strong P2Y12 inhibitors being assessed without concomitant aspirin.

Source guidance details

Comes from guidance
Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease
Number
CG172
Date issued
November 2013

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 19/12/2013