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Clopidogrel Outperforms Aspirin for Secondary Prevention in Coronary Artery Disease

An individual‑patient meta‑analysis presented at the ESC Congress and published in The Lancet found a 14% lower rate of major cardiovascular or cerebrovascular events without more major bleeding.

Man looking at white medication box.
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Overview

  • Researchers pooled seven randomized trials following 28,982 patients with coronary artery disease for about 5.5 years, with roughly equal numbers assigned to clopidogrel and aspirin.
  • The reduction in heart attack, stroke or cardiovascular death with clopidogrel was consistent across key subgroups, including patients predicted to respond less well to the drug.
  • Major bleeding risk was comparable between therapies, with 256 deaths or major bleeds on clopidogrel versus 279 on aspirin, a difference that was not statistically significant.
  • Study authors say the findings support preferring clopidogrel for long‑term monotherapy in stable CAD, while calling for cost‑effectiveness analyses and formal guideline review before widespread switching.
  • Both medicines are generic and widely available; NHS tariff data cited in coverage list clopidogrel at about 3.6p per tablet versus aspirin at about 2.5p, and clinicians advise patients to consult their doctor before changing therapy.