A large new study suggests that clopidogrel, a common medicine used to prevent blood clots, may offer better long-term protection than aspirin for people with coronary artery disease.
The findings could eventually change how doctors prevent heart attacks and strokes in millions of people who already have heart disease. The research was published in The Lancet.
Coronary artery disease happens when fatty material builds up inside the blood vessels that carry oxygen-rich blood to the heart. Over time, these vessels can become narrow or blocked, which can cause chest pain, a heart attack, or other serious problems. The disease is extremely common and remains a major cause of illness and death around the world.
People who have had a heart attack or a procedure to open a blocked heart artery are often given medicines that make blood clots less likely to form. These medicines are especially important after a stent is placed inside an artery to keep it open. After the early treatment period, many patients continue taking one anti-clotting medicine for years or even for life.
For decades, aspirin has been the usual choice for this long-term treatment. It is cheap, easy to obtain, and has a long history of helping prevent heart attacks and strokes. However, researchers have increasingly asked whether another widely used medicine, clopidogrel, might do an even better job.
To investigate, researchers combined information from seven major clinical trials involving nearly 29,000 people with coronary artery disease. Combining several carefully designed trials allows researchers to study a much larger group of patients and can provide stronger evidence than looking at one study alone. The analysis directly compared people taking clopidogrel with those taking aspirin.
The results favored clopidogrel. People who took clopidogrel had a 14% lower risk of major heart and blood vessel problems, including heart attacks and strokes, compared with those taking aspirin. This difference suggests that clopidogrel could provide stronger protection for people who already have coronary artery disease.
One important concern with any medicine that reduces blood clotting is bleeding. If a drug prevents clotting too strongly, serious bleeding can sometimes occur in the stomach, brain, or other parts of the body. In this analysis, however, clopidogrel did not cause more major bleeding than aspirin.
The researchers also looked at different types of patients, including people with coronary stents and people who had previously experienced serious heart problems. They examined whether genetic differences or other health factors might make clopidogrel less effective for some patients.
Overall, clopidogrel still performed better than aspirin, including among people expected to have a weaker response to the medicine.
These findings are important because both drugs are already widely available and familiar to doctors. If future studies continue to support the results, medical guidelines may increasingly recommend clopidogrel rather than aspirin for some people who need lifelong treatment after coronary artery disease.
Researchers say more work is still needed to study costs and confirm the benefits in larger and more diverse populations.
For now, patients should not change their medicine on their own. Aspirin and clopidogrel can have different benefits and risks depending on a person’s health, other medicines, and history of bleeding. Anyone considering a change should first speak with the doctor managing their heart disease.
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