CLARITY about the use of clopidogrel in patients with acute coronary syndromes and myocardial infarction

Clopidogrel was shown to have added benefits to aspirin in patients with acute coronary syndromes without ST-segment elevation in the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial. The cost in CURE was estimated to be US442 dollars greater in the clopidogrel group and the incremental cost-effectiveness ratio (incremental cost/life-year gained) was US6318 dollars. Clopidogrel has also recently been shown to have added benefits to aspirin in patients with myocardial infarction with ST-segment elevation in the Clopidogrel as Adjunctive Reperfusion Therapy (CLARITY)--Thrombolysis in Myocardial Infarction (TIMI) 28 study. The primary efficacy composite end point in CLARITY was an occluded infarct-related artery, death from any cause prior to angiography, or recurrent myocardial infarction, and this end point occurred less in the clopidogrel group (15%, 262 of 1752 patients) than placebo group (21.7%, 377 of 1739 patients). This difference was predominantly due to a reduction in the occluded infarct-related artery, which occurred in less of the clopidogrel (11.7%) than placebo group (18.4%). There was also a reduction in urgent revascularisations in the clopidogrel group of CLARITY. Thus, clopidogrel is effective and cost effective in acute coronary syndromes, and is also beneficial in patients with myocardial infarction with ST-segment elevation.     

Clopidogrel: a pharmacoeconomic review of its use in patients with non-ST elevation acute coronary syndromes

Clopidogrel (Plavix) is a selective inhibitor of adenosine diphosphate-induced platelet aggregation. In patients with acute coronary syndromes (ACS) [unstable angina or non-ST-segment elevation myocardial infarction], clopidogrel plus aspirin (acetylsalicylic acid) for up to 1 year significantly reduced the risk of cardiovascular events relative to placebo plus aspirin in the well designed clinical trial CURE (Clopidogrel in Unstable angina to prevent Recurrent Events) and its substudy in patients undergoing percutaneous coronary intervention (PCI) [PCI-CURE]. In pharmacoeconomic evaluations based on data from these trials conducted in a number of countries that used a variety of models, methods and/or type of costs, clopidogrel plus aspirin was consistently predicted to be cost effective relative to aspirin alone in the management of patients with ACS, including those undergoing PCI. Clopidogrel plus aspirin in patients with ACS reduced the incremental cost per cardiovascular event prevented and/or life-year gained (LYG) relative to aspirin alone in analyses using within-trial data (including longer-term analyses incorporating life-expectancy estimates) from the CURE or PCI-CURE studies. In Markov models of cost effectiveness with a lifetime horizon from a healthcare payer perspective based on the CURE trial, relative to aspirin alone, clopidogrel plus aspirin for 1 year was predicted to have incremental costs per LYG of 8132Euro in Spain (2003 values) and 1365Euro in Sweden (2000 values). In similar Swedish analyses from a healthcare payer perspective, clopidogrel plus aspirin for 1 year was predicted to have incremental costs per LYG of 10,993Euro (2004 values) relative to aspirin alone based on data from the PCI-CURE substudy. Broadly similar results have also been reported in modelled analyses from other countries. Cost-utility analyses based on the CURE trial suggest that, relative to lifelong aspirin alone, clopidogrel plus aspirin for 1 year followed by aspirin alone is associated with incremental costs per QALY gained that are below the traditional threshold of cost utility in Spain, the UK and the US. In patients with ACS, including those undergoing PCI, the addition of clopidogrel to standard therapy with aspirin is clinically effective in preventing cardiovascular events. Available pharmacoeconomic data from several countries, despite some inherent limitations, support the use of clopidogrel plus aspirin for up to 1 year as a cost-effective treatment relative to aspirin alone in this patient population.     

Mesalazine for the treatment of inflammatory bowel disease

Clopidogrel has become a mainstay in the management of acute coronary syndrome patients over the past decade, as well as an essential component of percutaneous coronary intervention (PCI) pharmacotherapy. Until recently, no prospective study has evaluated the effectiveness of clopidogrel in the setting of an ST-segment elevation myocardial infarction (STEMI). The majority of patients presenting with STEMI receive thrombolytic therapy (aspirin, heparin and a fibrinolytic agent) although many do not achieve or maintain adequate reperfusion of the infarct-related artery. The CLARITY (Clopidogrel as Adjunctive Reperfusion Therapy) study and the PCI–CLARITY substudy were designed to address whether a beneficial effect of clopidogrel, including a loading dose, would be attained among STEMI patients who were being treated with thrombolytic therapy and undergoing coronary angiography during the index hospitalisation. A total of 3491 patients who presented within 12 h after the onset of STEMI were randomly assigned to receive clopidogrel (300-mg loading dose followed by 75 mg daily) or placebo. Patients were scheduled to undergo coronary angiography after 48 h, and those who underwent PCI during the index hospitalisation formed the basis of PCI–CLARITY. This PCI cohort was followed for the combined end point of cardiovascular death, recurrent myocardial infarction and stroke for 30 days.     

Clopidogrel and acute coronary syndrome

Clopidogrel (Plavix-Sanofi-Synthelabo & Bristol-Myers Squibb) blocks platelet aggregation through an action distinct from that of aspirin. In the UK, it is licensed for the secondary prevention of atherosclerotic events and for this, we concluded 3 years ago that clopidogrel "appears to offer no worthwhile advantage over aspirin". After publication of the CURE (Clopidogrel in Unstable angina to prevent Recurrent Events) trial, which assessed adjunctive use of clopidogrel with aspirin in patients with acute coronary syndrome without ST-segment elevation (unstable angina or non-Q wave infarction), clopidogrel was hailed in the lay media as "the biggest breakthrough in 20 years". Do the CURE study results warrant the use of clopidogrel in patients with acute coronary syndrome without ST elevation (currently an unlicensed indication)?     

Clopidogrel: a CURE in acute coronary syndromes?

The standard approach to preventing acute coronary syndromes (ACSs)has been to inhibit platelet aggregation with aspirin and to inhibit blood coagulation with low molecular-weight heparin (LMWH). Even with this combination there is still a substantial short and long-term cardiovascular risk. The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial [1] compared clopidogrel plus aspirin against aspirin alone in patients with ACSs. The clopidogrel regimen was a loading dose of 300 mg p.o. followed by 75 mg/day and the recommended dose of aspirin was 75 - 325 mg/day. The first primary outcome was a composite of death from cardiovascular causes, non-fatal myocardial infarction (MI) or stroke and this occurred significantly less often in the clopidogrel than the placebo group (9.3 vs. 11.4%). Although there were more clopidogrel patients with life-threatening bleeding (clopidogrel 2.2%, placebo 1.8%), this represented GI haemorrhages and bleeding at sites of arterial puncture rather than fatal bleeding. This trial suggests a role for clopidogrel in the long-term treatment of ACSs.     

Clopidogrel in ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention

Clopidogrel has become a mainstay in the management of acute coronary syndrome patients over the past decade, as well as an essential component of percutaneous coronary intervention (PCI) pharmacotherapy. Until recently, no prospective study has evaluated the effectiveness of clopidogrel in the setting of an ST-segment elevation myocardial infarction (STEMI). The majority of patients presenting with STEMI receive thrombolytic therapy (aspirin, heparin and a fibrinolytic agent) although many do not achieve or maintain adequate reperfusion of the infarct-related artery. The CLARITY (Clopidogrel as Adjunctive Reperfusion Therapy) study and the PCI-CLARITY substudy were designed to address whether a beneficial effect of clopidogrel, including a loading dose, would be attained among STEMI patients who were being treated with thrombolytic therapy and undergoing coronary angiography during the index hospitalisation. A total of 3491 patients who presented within 12 h after the onset of STEMI were randomly assigned to receive clopidogrel (300-mg loading dose followed by 75 mg daily) or placebo. Patients were scheduled to undergo coronary angiography after 48 h, and those who underwent PCI during the index hospitalisation formed the basis of PCI-CLARITY. This PCI cohort was followed for the combined end point of cardiovascular death, recurrent myocardial infarction and stroke for 30 days.     

三联疗法治疗急性ST段抬高型心肌梗死的疗效观察

目的:观察氯吡格雷联合阿司匹林和尿激酶治疗急性ST段抬高型心肌梗死的临床疗效。方法:将2009年6月-2010年6月我院60例确诊的急性ST段抬高型心肌梗死患者随机均分为观察组(氯吡格雷联合阿司匹林和尿激酶治疗)和对照组(阿司匹林和尿激酶治疗),比较2组治疗急性ST段抬高型心肌梗死的临床疗效。结果:观察组总有效率为93.33%,对照组为63.33%,观察组疗效明显高于对照组,2组比较差异有统计学意义(P<0.01)。对照组不良反应发生率(33.33%)高于观察组(3.33%),2组比较差异有统计学意义(P<0.05)。结论:氯吡格雷联合阿司匹林和尿激酶治疗急性ST段抬高型心肌梗死疗效确切,不良反应少。     

Clopidogrel Bisulfate

Clopidogrel bisulfate (hereafter, clopidogrel), a selective inhibitor of ADP-induced platelet aggregation, is approved for the reduction of atherothrombotic events in patients with ST-segment elevation myocardial infarction (STEMI). In COMMIT/CCS-2, a well designed trial in 45,852 adult patients with STEMI, relative to aspirin alone, clopidogrel 75 mg/day plus aspirin treatment significantly reduced the risk of both coprimary endpoints: the composite endpoint of reinfarction, stroke, or death from any cause and the risk of death from any cause. Based on the findings of this trial, treating 1000 patients for approximately 2 weeks with clopidogrel is associated with nine fewer patient deaths, reinfarctions, or strokes during treatment. In CLARITY-TIMI 28, a well designed supportive study in 3491 adult patients with STEMI, clopidogrel plus aspirin reduced the odds that a composite primary endpoint event of an occluded infarct-related artery, recurrent myocardial infarction, or death from any cause would occur versus aspirin plus placebo. Clopidogrel treatment was generally well tolerated in these clinical trials, with no significant between-group difference in the rate of major bleeding in either trial. Experience in other patient populations (e.g. those with recent myocardial infarction, recent ischemic stroke, or established peripheral arterial disease) has shown that longer-term (< or =3 years) clopidogrel monotherapy is generally well tolerated.     

The value of clopidogrel in addition to standard therapy in reducing atherothrombotic events

The recent multinational, randomised, prospective studies Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE), Percutaneous Coronary Intervention substudy of CURE (PCI-CURE) and Clopidogrel for the Reduction of Events During Observation (CREDO) have demonstrated the clinical efficacy and safety of clopidogrel for the treatment of patients with non-ST-segment elevation acute coronary syndromes (ACS), including those undergoing percutaneous coronary intervention. In these settings, clopidogrel significantly reduces the risk of atherothrombotic events, with relative risk reductions of 20-30% (absolute risk reduction 1.9-3.0%). Health economic evaluations based on data from these studies conducted in Europe and the United States have clearly demonstrated the cost-effectiveness of clopidogrel in combination with aspirin compared with aspirin alone for the management of ACS. Within-trial evaluations based on CURE and PCI-CURE data showed that treatment with clopidogrel on top of standard therapy reduced the cost of initial hospitalisation as well as the total cost associated with hospitalisations. Long-term economic analyses based on the CURE study demonstrate that clopidogrel is cost saving in the Netherlands and that the cost per life-year gained (LYG) in other European countries is between Euros 549 and Euros 5048. In the United States, the cost per LYG for clopidogrel has been assessed at US dollars 6173 on the basis of CURE, US dollars 5910 for PCI-CURE and US dollars 3685 for CREDO, all of which are considerably lower than that associated with common cardiovascular benchmarks. The results are robust and consistent across different countries using varying costing strategies and estimates of survival. In conclusion, these data demonstrate that clopidogrel in combination with aspirin for the management of ACS is both clinically effective and cost-effective in this setting.     

Incremental Effect of Clopidogrel on Important Outcomes in Patients with Cardiovascular Disease

OBJECTIVES: To quantify the impact of clopidogrel plus aspirin on the individual outcomes of death, myocardial infarction, or stroke in patients with established cardiovascular disease, or in patients with multiple risk factors for vascular disease. BACKGROUND: Randomized trials have demonstrated a reduction in composite outcomes when clopidogrel is added to aspirin therapy in patients with coronary artery disease; however, the magnitude of benefit on individual outcomes is unknown. METHODS: We conducted a meta-analysis on randomized, controlled trials that compared aspirin plus clopidogrel with aspirin plus placebo for the treatment of coronary artery disease. RESULTS: This analysis included five randomized trials (CURE, CREDO, CLARITY, COMMIT, and CHARISMA) in 79 624 patients. The incidence of all-cause mortality was 6.3% in the aspirin plus clopidogrel group versus 6.7% in the aspirin group (odds ratio [OR] 0.94; 95% CI 0.89, 0.99; p = 0.026). The incidence of myocardial infarction was 2.7% and 3.3% (OR 0.82; 95% CI 0.75, 0.89; p < 0.0001), and stroke was 1.2% and 1.4% (OR 0.82; 95% CI 0.73, 0.93; p = 0.002). Similarly, the incidence of major bleeding was 1.6% and 1.3% (OR 1.26; 95% CI 1.11, 1.41; p < 0.0001), and fatal bleeding was 0.28% and 0.27% (OR 1.04; 95% CI 0.76, 1.43; p = 0.79). CONCLUSION: The addition of clopidogrel to aspirin results in a small reduction in all-cause mortality in patients with ST-elevation myocardial infarction and a modest reduction in myocardial infarction and stroke in patients with cardiovascular disease. The overall incidence of major bleeding however is increased, although there is no excess of fatal bleeds or hemorrhagic strokes.     

2型糖尿病对急性ST段抬高型心肌梗死患者氯吡格雷抵抗的影响

目的 探讨2型糖尿病对急性ST段抬高型心肌梗死患者氯吡格雷抵抗的影响.方法 入选首都医科大学附属北京安贞医院就诊的急性ST段抬高型心肌梗死患者978例,分为2型糖尿病组（272例）和非2型糖尿病组（706例）,术前给予氯吡格雷,总量≥300 mg,将5μmol/L二磷酸腺苷诱导的血小板聚集率大于50％定义为氯吡格雷抵抗.观察2型糖尿病组和非2型糖尿病组氯吡格雷抵抗发生率及联合终点事件的差异.结果 2型糖尿病组氯吡格雷抵抗发生率明显高于非糖尿病组氯吡格雷抵抗发生率[（44.1％（120/272）比14.7％（104/706）,P=0.017],联合终点事件发生率也明显高于非2型糖尿病组[16.2％ （44/272）比7.4％（52/706）,P=0.012].Logistic回归分析显示,2型糖尿病是影响急性ST段抬高型心肌梗死患者氯吡格雷抵抗的独立预测因素[比值比为4.710,95％置信区间为1.380 ～ 7.551,P=0.028）.结论 2型糖尿病是影响急性ST段抬高型心肌梗死患者氯吡格雷抵抗的独立预测因素.     

波立维联合阿司匹林肠溶片治疗非ST段抬高型心肌梗死的疗效观察

目的观察硫酸氯吡格雷(波立维)联合阿司匹林肠溶片治疗非ST段抬高型心肌梗死(NSTEMI)的临床疗效。方法 NSTEMI患者180例随机分为观察组和对照组各90例。对照组在常规治疗基础上给予波立维治疗;观察组在对照组治疗基础上加服阿司匹林肠溶片。2组疗程均为8周。观察比较2组的临床疗效和心脏不良事件。结果观察组总有效率为94.4%高于对照组的81.1%,心脏不良事件发生率为0低于对照组的7.8%,差异均有统计学意义(P<0.05)。结论波立维联合阿死匹林肠溶片治疗NSTEMI,临床效果显著,不良反应小,安全可靠。     

Prevention of coronary heart disease with aspirin and clopidogrel: efficacy, safety, costs and cost-effectiveness

Atherothrombotic coronary artery disease is the single most common cause of death worldwide and a growing public health problem. Platelets play a central role in the pathogenesis of atherothrombosis and are therefore commonly targeted by one or more antiplatelet drugs as part of primary and secondary atherothrombosis prevention strategies. Aspirin reduces the risk of serious vascular events (myocardial infarction, stroke or cardiovascular death) by approximately 20% in a broad range of high-risk patients and remains the first-line antiplatelet drug because of its relative safety, low cost and cost-effectiveness. Compared with aspirin alone, clopidogrel reduces the risk of serious vascular events by approximately 10% and the combination of aspirin and clopidogrel reduces the risk by approximately 20% in patients with non-ST-segment elevation acute coronary syndrome. Clopidogrel has a similar safety profile to aspirin but clopidogrel tablets are substantially more expensive. However, the incremental cost-effectiveness ratio of clopidogrel compared with aspirin is favourable, particularly in high-risk patients and is intermediate compared with a range of other effective therapeutic strategies for the treatment of coronary heart disease. Clopidogrel should be considered as a replacement for aspirin in patients who are allergic to aspirin, cannot tolerate aspirin, have experienced a recurrent atherothrombotic vascular event whilst taking aspirin and are at very high absolute risk of a serious vascular event (e.g., > 20%/year). The combination of clopidogrel and aspirin should be considered in patients with non-ST-segment elevation acute coronary syndrome or undergoing percutaneous coronary intervention.     

ST段抬高急性心肌梗死纤溶治疗加用氯吡格雷的临床研究

目的:评价ST段抬高急性心肌梗死rt-PA纤溶治疗加用氯吡格雷的有效性和安全性。方法:87例ST段抬高的急性心肌梗死患者,90 min内经静脉接受50 mg rt-PA纤溶治疗,按是否加用氯吡格雷随机分两组:治疗组每天给予氯吡格雷75 mg,对照组给予安慰剂。临床观察指标为梗死血管远端TIMI级血流、冠脉内血栓、出血并发症、住院期间心血管事件。结果:氯吡格雷治疗组梗死血管远端TIMI级血流比对照组显著升高(72.1%vs50.0%,P<0.05),治疗组冠脉内血栓比对照组显著降低(34.9%vs 56.8%,P<0.05)。两组出血并发症无统计学差别(P>0.05)。两组再梗死、心源性死亡、总死亡差异无显著性(P>0.05)。结论:ST段抬高急性心肌梗死rt-PA纤溶治疗加用氯吡格雷改善梗死血管通畅率,并不增加出血并发症。     

Cost-effectiveness of clopidogrel treatment in percutaneous coronary intervention: a European model based on a meta-analysis of the PCI-CURE,CREDO and PCI-CLARITY trials*

ABSTRACT

Objective: Our objective was to conduct a comprehensive cost-effectiveness analysis of pre-treatment and long-term treatment with clopidogrel in percutaneous coronary intervention (PCI) in three European countries based on a meta-analysis of the PCI-Clopidogrel in Unstable angina to prevent Recurrent Events (CURE), Clopidogrel for the Reduction of Events During Observation (CREDO) and PCI-Clopidogrel as Adjunctive Therapy (CLARITY) trials. This analysis adds to existing knowledge by providing further data on the cost-effectiveness of clopidogrel in PCI across a wide spectrum of patients.

Methods: A combined decision tree and Markov model was created. The relative risks of myocardial infarction, cardiovascular death and of major bleedings with clopidogrel were based on a fixed-effects meta-analysis. The risk of ischaemic events in untreated patients and long-term survival were taken from the Swedish hospital and death registers. A societal perspective was used in Sweden and a payer perspective in Germany and France. Costs are stated in €2006 and effectiveness measured in quality-adjusted life-years (QALYs).

Results: The pooled effects of clopidogrel on the combined endpoint showed a relative risk of 0.711 (p = 0.003) at 30 days and 0.745 (p = 0.002) at end of follow-up (up to 1 year). Pre-treatment with clopidogrel compared with aspirin alone is a dominant strategy. Long-term treatment with clopidogrel compared with 1-month treatment leads to approximately 0.09 QALYs at an incremental cost of €393 in Sweden, €709 in Germany and €494 in France. The corresponding incremental cost-effectiveness ratios range from €4225/QALY to €7871/QALY.

Conclusion: The results of this modelling analysis suggest that pre-treatment and long-term treatment in PCI with clopidogrel for up to 1 year are cost-effective in a range of patient groups and settings given commonly accepted thresholds.     

Clopidogrel

? Clopidogrel is a selective inhibitor of ADP-induced platelet aggregation.

? A large, multicenter, randomized study in 12562 patients with acute coronary syndromes without ST-segment elevation demonstrated that treatment with clopidogrel (loading dose of 300mg followed by once daily treatment with 75mg) in addition to standard therapy including aspirin (75 to 325 mg/day) significantly reduced the risk of the combined endpoint of cardiovascular death, myocardial infarction or stroke compared with treatment with standard therapy. Furthermore, the composite risk of these outcomes or refractory ischemia was also significantly reduced in patients treated with clopidogrel plus aspirin. The effects of clopidogrel were independent of background treatment with cardiovascular medications and/or interventions.

? The risk of severe ischemia, recurrent angina or heart failure was also significantly reduced in patients receiving clopidogrel plus aspirin. There was also a significant reduction in the need for coronary revascularization during the initial period of hospitalization.

? In patients undergoing percutaneous coronary intervention (PCI), the relative risk of the combined endpoint of cardiovascular death, myocardial infarction or urgent target-vessel revascularization within 30 days of the intervention was significantly reduced. Moreover, the relative risk of the single endpoint of myocardial infarction within 30 days of PCI was significantly in favor of clopidogrel-treated patients.

? Hemorrhagic events (both major and minor) were significantly more frequent in patients with acute coronary syndromes receiving treatment with clopidogrel plus aspirin than in patients treated with aspirin alone. This was largely attributable to an increased incidence in the rate of gastrointestinal hemorrhage and bleeding at the site of arterial puncture. However, there was no difference between the two groups in the incidence of bleeding episodes that were considered to be life-threatening.

     

高剂量氯吡格雷治疗老年急性非ST段抬高型心肌梗死的疗效观察

目的探讨高剂量氯吡格雷治疗老年急性非ST段抬高型心肌梗死的临床疗效。方法选择2006年1月-2010年1月在我院住院的老年急性NSTEMI患者118例,并随机分为对照组与观察组,每组各59例,对照组采用肠溶阿司匹林、低分子肝素及抗心绞痛药物治疗,观察组则在对照组的基础上加用大剂量氯吡格雷治疗,并比较两组临床疗效及两组用药前后心电图ST段改变,血PT、APTT和PLT变化。结果观察组总有效率为98．31％,对照组为81．36％,两组相比较差异有统计学意义（P〈0．05）,两组血清标志物组间、组内比较差异有统计学意义（P〈0．05）。结论高剂量氯吡格雷治疗老年急性非卵段抬高型心肌梗死疗效显著,安全有效可靠。     

Clopidogrel: a review of its use in the prevention of atherothrombosis

Clopidogrel is an ADP receptor antagonist that is indicated for the reduction of atherosclerotic events including myocardial infarction, ischaemic stroke and vascular death in patients with atherosclerosis manifested by recent stroke, myocardial infarction or established peripheral vascular disease. In the 19 185 patients enrolled in the multicentre, randomised double-blind CAPRIE study, the annual risk of the combined end-point of ischaemic stroke, myocardial infarction and death from vascular disease (vascular death) was significantly lower during treatment with clopidogrel 75 mg/day than aspirin 325 mg/day [5.3 vs 5.8%/year, respectively; relative risk reduction (RRR) 8.7%, p = 0.043] after a mean follow-up of 1.9 years. Clopidogrel provided even greater reductions in the risk of recurrent ischaemic events than aspirin in patients with a history of coronary artery bypass surgery, diabetes mellitus and in those receiving concomitant lipid-lowering therapy. Moreover there was a significant reduction in the incidence of hospitalisation in patients treated with clopidogrel. In a patient population (Saskatchewan, Canada) with a greater risk of ischaemic events than the CAPRIE study population, the number of patients needed to be treated with clopidogrel to prevent 1 ischaemic event was estimated to be 70 (vs 200 in the CAPRIE study). In randomised trials and registry surveys, clopidogrel 75 mg/day plus aspirin had similar efficacy (as measured by adverse cardiac outcomes) to ticlopidine 250mg twice daily plus aspirin during the 30 days after placement of intracoronary stents. Tolerability of clopidogrel was significantly better than ticlopidine in the randomised, double-blind CLASSICS study. Among patients treated with clopidogrel or aspirin in the CAPRIE study, the overall gastrointestinal tolerability of clopidogrel was generally better than that of aspirin; the frequency of gastrointestinal haemorrhage was significantly lower among patients treated with clopidogrel than aspirin. Diarrhoea, rash and pruritis were significantly more common with clopidogrel than aspirin. CONCLUSION: Clopidogrel was significantly more effective than aspirin in the prevention of vascular events (ischaemic stroke, myocardial infarction or vascular death) [corrected] in patients with atherothrombotic disease manifested by recent myocardial infarction, recent ischaemic stroke or symptomatic peripheral arterial occlusive disease [corrected] in the CAPRIE study. The overall tolerability profile of the drug was similar to that of aspirin, although gastrointestinal haemorrhage occurred significantly less often in clopidogrel recipients. The drug is widely used in combination with aspirin for the prevention of atherothrombosis after placement of intravascular stents, and available data suggest that this combination is as effective as ticlopidine plus aspirin for this indication.     

氯吡格雷联合阿司匹林治疗急性非ST段抬高型心肌梗死的临床效果

目的:观察氯吡格雷联合阿司匹林在急性非ST段抬高型心肌梗死治疗中的临床疗效,为该病的用药方案提供依据。方法:本组研究以我院于2018年1~12月收治的100例急性非ST段抬高型心肌梗死患者作为研究样本,采用数字信封法平均分为对照组与观察组。对照组单纯给予阿司匹林治疗,观察组在阿司匹林治疗的基础上联合氯吡格雷,观察两组的临床治疗效果,并观察用药期间两组心血管不良事件(MACE)的发生率与不良反应发生情况。结果:①观察组显效21例,有效24例,无效5例,总有效率为90%,明显高于对照组(74%,37/50),差异具有统计学意义(P<0.05)。②用药期间,观察组的不良反应发生率为10%;对照组共出现MACE3例、皮疹1例、血小板减少2例,发生率为12%;两组无显著差异,不具有统计学意义(P>0.05)。结论:氯吡格雷联合阿司匹林在急性非ST段抬高型心肌梗死临床治疗中的效果确切,而且不会增加MACE与不良反应的发生风险,安全性高,可以推广。