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Summary
Recent randomised, prospective studies have demonstrated the clinical efficacy and safety of clopidogrel in the treatment of patients with acute coronary syndromes, including those treated with primary percutaneous intervention. In these settings clopidogrel decreased the risk of atherothrombotic events by 20–30%.
The use of clopidogrel instead of aspirin, for secondary prevention in patients with stable cardiovascular disease, results in a modest 8.7% relative risk reduction. However, clinical trial failed to show benefit in patients treated with clopidogrel added to aspirin in this population.
Economic analyses conducted in the US and Europe demonstrated the cost effectiveness of clopidogrel in combination with aspirin in patients with acute coronary syndromes, and showed a favourable economic profile for clopidogrel compared with other cardiovascular interventions. On the other hand, the data for the use of clopidogrel in patients with stable cardiovascular disease either alone or in combination with aspirin is not as compelling.