Clopidogrel or ticagrelor may be safer and more effective than traditional aspirin for secondary prevention, suggests evidence from seven randomized trials. MedTwitter
Current guidelines recommend aspirin for antiplatelet monotherapy for patients with established CAD, Gragnano said, but"the primacy of aspirin in secondary prevention is based on historical trials conducted in the 1970s and 1980s and may not apply to contemporary practice."inhibitors with aspirin for secondary prevention produced"inconsistent results," possibly owing to their heterogeneous populations of patients with coronary, cerebrovascular, or, he said.
Most of the seven trials' 24,325 participants had a history of MI, and some had peripheral artery disease ; the rates were 56.2% and 9.1%, respectively. Coronary revascularization, either percutaneous or surgical, had been performed for about 70%. Most had presented withAbout 76% of the combined cohorts were from Europe or North America; the rest were from Asia. The mean age of the patients was 64 years, and about 22% were women.
The corresponding HR for MI was 0.77 , for an NNT benefit of 136. For net adverse clinical events, the HR was 0.89 , for an NNT benefit of 121. Risk for major bleeding was not significantly different , nor were risks for stroke or cardiovascular death (HR, 1.02; 95% CI, 0.86 – 1.20;
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