Therapeutic benefit - Aspirin revisited in light of the introduction of clopidogrel

Background-Antiplatelet agents are widely recognized for their efficacy in reducing the occurrence of vascular events in patients with atherothromboti c disease. Aspirin is currently considered to be the "reference standard" a ntiplatelet agent and is recommended by the American Heart Association for use in patients with a wide range of manifestations of cardiovascular disea se on the basis of its high benefit-to-risk and benefit-to-cost ratios. Rec ently, clopidogrel (Plavix, Bristol-Myers Squibb Co), another antiplatelet agent, was approved by the Food and Drug Administration for many of the sam e indications as aspirin. Summary of Review-Because physicians will be faced with deciding whether to switch sam the well-established practice of recommending aspirin for use i n patients with atherothrombotic disease, both aspirin and clopidogrel are compared with respect to the primary factors that influence such decisions tie, their relative efficacy, safety, cost, and convenience of use). Conclusions-Based on the available evidence, aspirin is preferred for the m ajority of stroke or myocardial infarction patients at risk of recurrent at herothrombotic events. Clopidogrel may, however, provide valuable therapeut ic benefit over aspirin in patients with peripheral arterial disease and in stroke or myocardial infarction patients for whom aspirin treatment is con traindicated or for whom aspirin fails to achieve the desired therapeutic e ffect.