Benefit of ADP receptor antagonists in atherothrombotic patients: New evidence

In the Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events ( CAPRIE) trial, clopidogrel showed a statistically significant superiority o ver aspirin in the prevention of ischaemic stroke, myocardial infarction an d vascular death in patients with symptomatic atherosclerosis. More recentl y, post-hoc analysis of the data also showed that repeat hospitalization fo r ischaemic or bleeding events was decreased with clopidogrel compared with aspirin. Complementary analyses show that the benefit of clopidogrel over aspirin is amplified in a large population at very high risk of further ath erothrombotic events (diabetics, patients with high cholesterol, and patien ts with previous manifestations of atherothrombosis). A potential clinicall y useful advantage of clopidogrel is its low propensity for adverse interac tion with angiotensin-converting enzyme (ACE) inhibitors, contrary to what may be seen with aspirin, as observed in a post-hoc CAPRIE analysis. The pu tative aspirin-ACE inhibitor interaction is being tested prospectively in t he Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial - a randomized comparison of warfarin, clopidogrel and aspirin in patients with chronic heart failure. The good gastrointestinal tolerance of clopido grel seen in CAPRIE has been further demonstrated in a study in healthy vol unteers where there was a markedly lower gastroduodenal erosion score after 8 days' administration of clopidogrel 75 mg/day compared with aspirin 325 mg/day (p < 0.001). Following the positive findings obtained with clopidogr el plus aspirin in the Clopidogrel Aspirin Stent International Cooperative Study (CLASSICS) trial, other studies of clopidogrel plus aspirin have been initiated or are planned. These include Management of Atherothrombosis wit h Clopidogrel in High-risk patients (MATCH), a randomized comparison of clo pidogrel plus aspirin versus clopidogrel in high-risk patients with recent stroke or transient ischaemic attack. Copyright (C) 2001 S. Karger AG, Base l.