MI, STROKE - CLOPIDROGEL DECREASES ISCHAEMIC STROKE, MI, VASCULAR DEATH COMPARED TO ASPIRIN

Citation/s:
CAPRIE steering committee. a randomised, blinded trial of clopidrogel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348:1329-39.

Three-part Clinical Question: In patients with history of MI or ischaemic stroke, does treatment with clopidrogel decrease risk of death compared to aspirin?
Search Terms: clopidrogel in Best Evidence

The Study:
Double-blinded concealed randomised controlled trial with intention-to-treat.
The Study Patients: pts with recent ischaemic stroke (< 6 months), recent MI (<35 days), or atherosclerotic peripheral arterial disease. Exclusion criteria were age <21, severe cerebral deficit, carotid endarterectomy (CEA) after qualifying stroke, qualifying stroke caused by CEA, life expectancy <3 yrs, uncontrolled hypertension, contraindication to study drugs, potential for pregnancy or previous participation in clopidrogel studies
Control group (N = 9586; 9586 analysed): aspirin 325 mg/d
Experimental group (N = 9599; 9599 analysed): clopidrogel 75 mg/d

The Evidence:

Outcome	Time to Outcome	CER	EER	RRR	ARR	NNT
stroke, MI or vascular death	1 yr	.107	.098	8%	0.009	111
95% Confidence Intervals:				0% to 16%	0.000 to 0.018	57 to 2398
all cause mortality	1 yr	.06	.058	3%	0.002	500
95% Confidence Intervals:				-8% to 14%	-0.005 to 0.009	NNT = 115 to INF; NNH = 214 to INF

Comments:

1. must consider cost of clopidrogel vs aspirin

2. clopidrogel was associated with a greater occurrence of severe rash but less GI haemorrhage than aspirin

Appraised by: Straus @ CEBM; Tuesday, July 21, 1998
Email: sharon.straus@clinical-medicine.ox.ac.uk
Kill or Update By: 1999

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