Does She Need Clopidogrel, Aspirin, or Both?
No fewer than 6 of the update/controversies sessions discussed new studies of clopidogrel. All the efficacy studies of clopidogrel have been compromised by the presumption that a placebo-controlled trial would be unethical, true or not. Consequently, the trials have been either comparisons of clopidogrel combined with aspirin versus aspirin, or clopidogrel alone versus aspirin.1 Plavix has been the subject of an unseemly patent battle that involved huge bribes and embarrassing litigation. Let’s face it, this is a drug that only a pharmaceutical company or an interventional cardiologist could trust. It is nominally superior to historic, cheap aspirin in preventing ischemic vascular events in high-risk patients—a difference that is of doubtful clinical significance; and the combination of clopidogrel and aspirin is marginally beneficial to aspirin even in acutely ill patients with unstable angina or myocardial infarction. Long-term therapy studies have not been encouraging, moreover. Bha
