A landmark study published in The Lancet has revealed that a cheap blood thinner, clopidogrel, costing less than 4p per tablet, is more effective than aspirin at reducing the risk of heart attack and stroke in patients with coronary artery disease (CAD). The analysis of seven trials involving nearly 29,000 patients found that clopidogrel cut the risk of heart attack, stroke, or death by an additional 14% compared to aspirin.
Researchers from a global consortium, including Imperial College London, concluded that clopidogrel offers “superior protection” and argued for its adoption as the preferred treatment on the NHS. Currently, millions of Britons with heart disease take daily aspirin to lower their risk, but the new evidence suggests switching could provide greater benefits without increasing the risk of major bleeding.
Professor Bryan Williams, chief scientific officer at the British Heart Foundation, said: “These findings are likely to impact the medications doctors prescribe to their patients to reduce their risk of future heart problems. This research suggests that clopidogrel, an alternative to aspirin, might be more effective at preventing recurrent heart attack or stroke. Importantly, these benefits come without a greater risk of major bleeding.”
Coronary artery disease affects 2.3 million people in the UK and is the most common type of heart disease. Patients with CAD have traditionally been prescribed lifelong aspirin, but evidence supporting its long-term benefits and safety has been limited. The new analysis, which followed patients for an average of 5.5 years, showed that those on clopidogrel were 14% less likely to suffer a heart attack, stroke, or die from a heart-related condition than those on aspirin. There was no statistically significant difference in rates of major bleeding between the two groups.
The findings were presented at the European Society of Cardiology congress in Madrid. The researchers wrote in The Lancet: “These results support a preference for clopidogrel over aspirin for chronic antiplatelet monotherapy for patients with stable CAD. The widespread availability, generic formulation, and affordability of clopidogrel further supports its potential for extensive adoption in clinical practice.”
