Therapy

Why?

• Adding clopidogrel to aspirin reduces myocardial infarction, heart failure and need for revascularisation, but increases the risk of bleeding. ^a There is no clear reduction in mortality. ^d  
• Patients on clopidogrel and aspirin are less likely to develop refractory ischaemia in hospital. ^a

Adding clopidogrel to aspirin reduces MI and the need for revascularisation but increases bleeding

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
acute coronary syndrome without ST elevation   a	clopidogrel and aspirin	placebo and aspirin	myocardial infarction at 12 months	11%	22% (10% to 32%)	68 (44 to 160)
			refractory ischaemia in hospital at days	2.9%	31% (14% to 45%)	110 (68 to 260)
			heart failure at 12 months	4.4%	18% (2% to 31%)	130 (68 to 1100)
			revascularisation procedure at 12 months	23%	8% (2% to 14%)	53 (30 to 220)
			major bleeding at 12 months	2.7%	-38% (-67% to -13%)	-99 (-250 to -62)