A major new study has found that clopidogrel, a commonly prescribed blood thinner, is more effective than aspirin at preventing heart attacks and strokes in patients with coronary artery disease (CAD), without increasing the risk of major bleeding. The findings, presented at the European Society of Cardiology congress in Madrid and published in the Lancet, could transform global health guidelines.
The international team of researchers analysed data from nearly 29,000 patients with CAD across seven clinical trials. They found that those taking clopidogrel had a 14% lower risk of major adverse cardiovascular or cerebrovascular events—including heart attack, stroke or cardiovascular death—compared with those taking aspirin. Crucially, rates of major bleeding were similar between the two drugs.
CAD is the most common form of heart disease, affecting over 300 million people worldwide, including 2.3 million in the UK. For decades, daily low-dose aspirin has been the standard treatment to reduce the risk of serious cardiovascular events in these patients. However, the study authors say the evidence supporting aspirin's long-term benefits has been limited.
Writing in the Lancet, the researchers stated: 'This comprehensive synthesis of available evidence indicates that, in patients with CAD, long-term clopidogrel monotherapy offers superior protection against major cardiovascular and cerebrovascular events compared with aspirin, without an excess risk of bleeding.' They added that the widespread availability, generic formulation and affordability of clopidogrel support its potential for extensive adoption in clinical practice.
Prof Bryan Williams, chief scientific and medical officer at the British Heart Foundation, noted that aspirin remains a common treatment but said the study provides compelling evidence for a switch to clopidogrel. The findings challenge longstanding recommendations and could lead to updated guidelines for the hundreds of millions of CAD patients worldwide.
