CHARISMA study clarifies when to use clopidogrel
Clopidogrel (Plavix) plus low-dose aspirin reduces cardiovascular events and deaths in patients with vascular disease compared with aspirin alone, a new study confirms. The study, which clarifies when to use
dual antiplatelet therapy, reveals that clopidogrel does not provide
the same benefit for patients with risk factors but no documented disease.
The CHARISMA (clopidogrel for high atherothrombotic risk and ischemic
stabilization management and avoidance) study randomised 15,603 patients
with previous cardiovascular or peripheral arterial disease or multiple
risk factors to daily clopidogrel (75 mg) or placebo, plus aspirin (75–162mg).
Results were reported at the American College of Cardiology annual scientific
session in Atlanta, Georgia, this week and online in The New England
Journal of Medicine (12 March).
They show the rate of myocardial infarction, stroke, or death from cardiovascular
causes in the subgroup of more than 12,000 patients with established
vascular disease was reduced by 12.5 per cent (6.9 per cent with clopidogrel
versus 7.9 per cent with placebo; P=0.046) after a median follow-up of
28 months. However, patients with risk factors but no documented disease
showed no reduction, with a trend to increased risk of events (6.6 per
cent with clopidogrel versus 5.5 per cent with placebo; P=0.20). This
dichotomy meant that results for the entire group did not reach significance
(6.8 per cent versus 7.3 per cent; P=0.22).
The lead investigator, Deepak Bhatt, Cleveland Clinic, Ohio, said: “The
findings confirmed previous studies showing benefit with clopidogrel
plus aspirin in patients with symptomatic atherothrombosis but showed
the potential harm outweighed the benefit in those who only had risk
factors.” |
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