Cardio Trial Files Throwback Thursday: Aspirin +/- Clopidogrel for CV Prevention, Clopidogrel vs. Aspirin in CV Disease, and Valsartan vs. Captopril in MI with LV Dysfunction
Clopidogrel and Aspirin versus Aspirin Alone for the Prevention of Atherothrombotic Events
Bhatt DL et al. NEJM (April 2006)
Bottom Line: This randomized, double-blind, placebo-controlled trial studied 15,603 patients with either clinically evident cardiovascular disease or multiple risk factors. Patients were assigned to receive either clopidogrel (75 mg per day) plus low-dose aspirin (75 to 162 mg per day) or placebo plus low-dose aspirin and followed for a median of 28 months. The primary outcome was a composite of myocardial infarction, stroke, or death from cardiovascular causes. The rate of the primary outcome was 6.8 percent with clopidogrel plus aspirin and 7.3 percent with placebo plus aspirin, showing no significant difference between the two groups. The rate of severe bleeding was 1.7 percent and 1.3 percent respectively. The results suggest no benefit from clopidogrel plus aspirin compared to aspirin alone.
A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE)
CAPRIE Steering Committee. The Lancet (November 1996)
Bottom Line: The CAPRIE trial was a randomized, blinded, international trial of 19,185 patients with atherosclerotic vascular disease. Patients were assigned to receive either clopidogrel (75 mg once daily) or aspirin (325 mg once daily) and mean follow-up of 1.93 years. The primary outcome was a composite of ischaemic stroke, myocardial infarction, or vascular death. Results showed that patients treated with clopidogrel had a statistically significant (p = 0.043) relative-risk reduction of 8.7% (95%CI, 0.3 to 16.5) (absolute risk, 5.3% vs 5.8%) in favour of clopidogrel compared to aspirin. There were no major differences in terms of safety.
Valsartan, Captopril, or Both in Myocardial Infarction Complicated by Heart Failure, Left Ventricular Dysfunction, or Both
Pfeffer MA et al. NEJM (November 2003)
Bottom Line: This was a double-blind, randomized controlled trial evaluating valsartan, captopril, or their combination in 14,703 patients post–acute myocardial infarction with left ventricular systolic dysfunction, heart failure, or both. Patients were randomized 0.5 to 10 days after infarction to receive valsartan (n = 4909), captopril (n = 4909), or both drugs combined (n = 4885), in addition to conventional therapy, with a median follow-up of 24.7 months. All-cause mortality was similar across groups: 979 deaths in the valsartan group, 958 in the captopril group, and 941 in the combination group (HR valsartan vs. captopril = 1.00; 97.5% CI, 0.90–1.11; P=0.98). The combination group had the highest rate of drug-related adverse events. Valsartan was noninferior to captopril, and combining both drugs increased side effects without improving survival.
Cardio Trial Files Issue #CRD-2025-09
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