Doctors have identified a drug that works better than aspirin in preventing heart attacks and strokes, a finding that could influence medical guidelines around the world.
For years, millions have been advised to take low-dose aspirin daily to reduce the risk of cardiovascular events, as it helps prevent blood clots. But new research suggests that clopidogrel, a widely used blood thinner, is more effective without adding extra risk.
The study was presented at the European Society of Cardiology congress in Madrid, with the results also published in the Lancet medical journal.
The international team, with researchers from the US, UK, Australia, Switzerland, and Japan, said clopidogrel was “superior” to aspirin and should lead to “extensive adoption” in medical practice.
The analysis covered nearly 29,000 patients with coronary artery disease (CAD), showing that clopidogrel reduced the risk of serious heart and stroke events more than aspirin, while major bleeding rates were similar for both drugs.
CAD, the world’s most common form of heart disease, affects more than 300 million people globally, including 2.3 million in the UK. It occurs when fatty deposits narrow the heart’s arteries, leading to angina or, in severe cases, heart attacks.
For decades, aspirin has been the standard long-term treatment for CAD patients. However, evidence for its lasting benefits has been limited. The new review of seven clinical trials found that patients on clopidogrel had a 14% lower chance of major cardiovascular or cerebrovascular events compared with those on aspirin.
In their Lancet paper, the study team wrote: “This comprehensive synthesis of available evidence indicates that, in patients with CAD, long-term clopidogrel monotherapy offers superior protection against major cardiovascular and cerebrovascular events compared with aspirin, without an excess risk of bleeding.
“The superior efficacy of clopidogrel v aspirin was consistent across multiple key subgroups, including individuals with clinical features predictive of poor clopidogrel responsiveness, supporting the generalisability of these findings to the broad spectrum of patients with CAD.
“These results support a preference for clopidogrel over aspirin for chronic antiplatelet monotherapy for patients with stable CAD. The widespread availability, generic formulation and affordability of clopidogrel further supports its potential for extensive adoption in clinical practice.”
The research covered a wide range of patients, including those who had stents fitted or experienced acute coronary syndrome, and found that even people expected to respond less effectively to clopidogrel still benefited from it.
Because both aspirin and clopidogrel are widely available, the findings could influence treatment guidelines globally. Researchers also noted that further studies on cost-effectiveness would help shape future recommendations.
Prof Bryan Williams, chief scientific and medical officer at the British Heart Foundation, said: “Aspirin is a commonly prescribed drug to help prevent repeat heart attacks and strokes. This research suggests that clopidogrel, an alternative to aspirin, might be more effective at preventing recurrent heart attack or stroke.
“Importantly, these benefits come without a greater risk of major bleeding. These findings are likely to impact the medications doctors prescribe to their patients to reduce their risk of future heart problems.”
