Abstract 19340: Long-term Clopidogrel Therapy and The Impact on CV Mortality: Lessons from the Large Randomized Controlled Trials
Objective: Long-term clopidogrel treatment has become standard of care for ACS patients treated with or without coronary intervention. Also for other indications, clopidogrel has been studied. Concerns have risen with regard to long-term safety, but a review has so far not been performed.
Methods: Analysis of cardiovascular mortality in the long-term randomized trials comparing clopidogrel-based versus non clopidogrel-based antiplatelet therapies: CAPRIE, CURE, CHARISMA, CREDO, TRITON TIMI-38, PLATO, ZEST/REAL-LATE, PROFESS and ACTIVE-A (n = 112285). We separately studied ACS trials with and without the intention for PCI before randomization, and the subgroup of all patients that underwent a PCI in the respective trials. We also studied stroke prevention trials, and the impact of control treatment: monotherapy (aspirin), or dual antiplatelet treatment (aspirin plus either ticagrelor, prasugrel or dipyridamole).
Results: Unlike all trials combined, the ACS trials show a significant mortality difference in favor of non-clopidogrel based therapy. This seems especially true for the subgroup analysis of all patients with a PCI. The observed difference in the ACS trials is driven by the trials with a control group of aspirin and a non-clopidogrel antiplatelet agent, and not in trials with aspirin monotherapy in the control arm.
Conclusions: Although concerns may have risen regarding long-term clopidogrel treatment, this is not supported by clinical data when compared to treatment with aspirin alone. Long-term therapy with the combination of aspirin and clopidogrel seems inferior to aspirin and newer antiplatelet drugs. More studies with the new P2Y12 receptor blockers with improved safety and efficacy are eagerly awaited.
- © 2010 by American Heart Association, Inc.