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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Effect of clopidogrel added to aspirin in patients with atrial fibrillation
New England Journal of Medicine, Volume 360, No. 20, Year 2009
Notification
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Description
BACKGROUND: Vitamin K antagonists reduce the risk of stroke in patients with atrial fibrillation but are considered unsuitable in many patients, who usually receive aspirin instead. We investigated the hypothesis that the addition of clopidogrel to aspirin would reduce the risk of vascular events in patients with atrial fibrillation. METHODS: A total of 7554 patients with atrial fibrillation who had an increased risk of stroke and for whom vitamin K-antagonist therapy was unsuitable were randomly assigned to receive clopidogrel (75 mg) or placebo, once daily, in addition to aspirin. The primary outcome was the composite of stroke, myocardial infarction, non-central nervous system systemic embolism, or death from vascular causes. RESULTS: At a median of 3.6 years of follow-up, major vascular events had occurred in 832 patients receiving clopidogrel (6.8% per year) and in 924 patients receiving placebo (7.6% per year) (relative risk with clopidogrel, 0.89; 95% confidence interval [CI], 0.81 to 0.98; P = 0.01). The difference was primarily due to a reduction in the rate of stroke with clopidogrel. Stroke occurred in 296 patients receiving clopidogrel (2.4% per year) and 408 patients receiving placebo (3.3% per year) (relative risk, 0.72; 95% CI, 0.62 to 0.83; P<0.001). Myocardial infarction occurred in 90 patients receiving clopidogrel (0.7% per year) and in 115 receiving placebo (0.9% per year) (relative risk, 0.78; 95% CI, 0.59 to 1.03; P = 0.08). Major bleeding occurred in 251 patients receiving clopidogrel (2.0% per year) and in 162 patients receiving placebo (1.3% per year) (relative risk, 1.57; 95% CI, 1.29 to 1.92; P<0.001). CONCLUSIONS: In patients with atrial fibrillation for whom vitamin K-antagonist therapy was unsuitable, the addition of clopidogrel to aspirin reduced the risk of major vascular events, especially stroke, and increased the risk of major hemorrhage. (ClinicalTrials.gov number, NCT00249873.) Copyright © 2009 Massachusetts Medical Society.
Authors & Co-Authors
Connolly, Stuart J.
Canada, Hamilton
Population Health Research Institute, Ontario
Pogue, Janice M.
Canada, Hamilton
Population Health Research Institute, Ontario
Hart, Robert G.
United States, San Antonio
University of Texas Health Science Center at San Antonio
Hohnloser, Stefan Hans
Germany, Frankfurt am Main
Universitätsklinikum Frankfurt
Pfeffer, Marc Allan
United States, Boston
Brigham and Women's Hospital
Chrolavicius, Susan
Canada, Hamilton
Population Health Research Institute, Ontario
Yusuf, Salim N.
Canada, Hamilton
Population Health Research Institute, Ontario
Commerford, Patrick Joseph
Unknown Affiliation
Flather, Marcus D.
Unknown Affiliation
Joyner, Campbell D.
Unknown Affiliation
Gaudin, Christophe
Unknown Affiliation
Blumenthal, Mel
Unknown Affiliation
Avezum, Álvaro Jr
Unknown Affiliation
Díaz, Rafaël J.
Unknown Affiliation
Dorian, Paul
Unknown Affiliation
Flaker, Greg C.
Unknown Affiliation
Fox, Keith A.A.
Unknown Affiliation
Goldhaber, Samuel Zachary
Unknown Affiliation
Golitsyn, Sergey P.
Unknown Affiliation
Halon, David A.
Unknown Affiliation
Hunt, Dereck L.
Unknown Affiliation
Janský, Petr
Unknown Affiliation
Karatzas, Nicholas B.
Unknown Affiliation
Kozan, Ömer
Unknown Affiliation
Le-Heuzey, Jean Yves F.
Unknown Affiliation
Lewis, Basil S.
Unknown Affiliation
Morais, João Carlos Araujo
Unknown Affiliation
Paolasso, Ernesto Andrés C.
Unknown Affiliation
Peters, Ron J.G.
Unknown Affiliation
Pfisterer, Matthias Emil
Unknown Affiliation
Piegas, Leopoldo Soares
Unknown Affiliation
Talajic, Mario R.
Unknown Affiliation
Valentín, Vicent
Unknown Affiliation
van Mieghem, Walter
Unknown Affiliation
Varigos, J.
Unknown Affiliation
Ameriso, Sebastián Francisco
Unknown Affiliation
Atra, M.
Unknown Affiliation
Berwanger, Otávio
Unknown Affiliation
Bornstein, Natan M.
Unknown Affiliation
Cöttin, Yves
Unknown Affiliation
de Raedt, Herbert J.L.P.
Unknown Affiliation
Dvorakova, H.
Unknown Affiliation
Fodor, Jiri George
Unknown Affiliation
Kalvach, Pavel
Unknown Affiliation
Laine, Mika K.
Unknown Affiliation
Leys, Dider
Unknown Affiliation
Maggioni, Aldo Pietro
Unknown Affiliation
Massaro, Ayrton Roberto
Unknown Affiliation
Mayosi, Bongani M.
Unknown Affiliation
Norrving, Bo
Unknown Affiliation
Peeters, André Philippe
Unknown Affiliation
Pěnička, Martin
Unknown Affiliation
Siva, Aksel
Unknown Affiliation
Steg, Philippe Gabriel
Unknown Affiliation
Widimsky, Petr
Unknown Affiliation
Albers, Gregory W.
Unknown Affiliation
Hankey, Graeme J.
Unknown Affiliation
Shuaib, Ashfaq
Unknown Affiliation
Wyse, D. George
Unknown Affiliation
Cairns, J. A.
Unknown Affiliation
Wittes, Janet Turk
Unknown Affiliation
Beresh, Heather
Unknown Affiliation
Gasic, Zora
Unknown Affiliation
Yuan, Fei
Unknown Affiliation
Ahuad-Guerrero, Rodolfo Andres
Unknown Affiliation
Bustamante-Labarta, Miguel H.
Unknown Affiliation
Chiale, Pablo Ambrosio
Unknown Affiliation
Cuneo, Carlos Alberto
Unknown Affiliation
Garrido, Marcelo A.
Unknown Affiliation
Hershson, Alejandro Rubén
Unknown Affiliation
Hominal, Miguel Angel
Unknown Affiliation
Luciardi, Héctor Lucas
Unknown Affiliation
Montaña, Oscar R.
Unknown Affiliation
Schygiel, Pablo Omar
Unknown Affiliation
Vogel, Daniel R.
Unknown Affiliation
Zaidman, Cesar Javier
Unknown Affiliation
Cross, David B.
Unknown Affiliation
Garrahy, Paul John
Unknown Affiliation
Rees, David M.
Unknown Affiliation
Huber, Kurt
Unknown Affiliation
Cools, Frank Johan C.
Unknown Affiliation
de Roy, Luc J.M.
Unknown Affiliation
Mairesse, Georges H.
Unknown Affiliation
Abrantes, José Antonio M.
Unknown Affiliation
Maia, Lília Nigro
Unknown Affiliation
Marin-Neto, José Antonio
Unknown Affiliation
Oigman, Wille
Unknown Affiliation
Précoma, Dalton Bertolim
Unknown Affiliation
Reis, Gilmar
Unknown Affiliation
Zimmermann, Sergio Luiz
Unknown Affiliation
Carroll, Sandra L.
Unknown Affiliation
Douketis, James Demetrios
Unknown Affiliation
Gupta, Milan K.
Unknown Affiliation
Krahn, Andrew D.
Unknown Affiliation
Ma, Patrick T.S.
Unknown Affiliation
Sapp, John Lewis
Unknown Affiliation
Corbalàn, Ramõn L.
Unknown Affiliation
Klimsa, Zdeněk
Unknown Affiliation
Špinar, Jindřich
Unknown Affiliation
Sp̌inarová, Lenka
Unknown Affiliation
Toušek, František
Unknown Affiliation
Husted, Steen Elkjær
Unknown Affiliation
Harjola, Veli Pekka
Unknown Affiliation
Huikuri, Heikki V.
Unknown Affiliation
Kettunen, Raimo V.J.
Unknown Affiliation
Peuhkurinen, Keijo J.
Unknown Affiliation
Defaye, Pascal
Unknown Affiliation
Mabo, Philippe
Unknown Affiliation
Poulard, Jean Ernest
Unknown Affiliation
Rey, Jean Luc
Unknown Affiliation
Borggrefe, Martin M.
Unknown Affiliation
Darius, Harald
Unknown Affiliation
Duray, Gabor Z.
Unknown Affiliation
Felix, Stephan Burkhard
Unknown Affiliation
Horacek, Thomas
Unknown Affiliation
Katus, Hugo Albert
Unknown Affiliation
Klepzig, Harald H.
Unknown Affiliation
Münzel, Tomas F.
Unknown Affiliation
Pieske, Burkert Mathias
Unknown Affiliation
Seidl, Karlheinz F.
Unknown Affiliation
Goudevenos, John A.
Unknown Affiliation
Keltai, Katalin
Unknown Affiliation
Tomcsányi, Jànos
Unknown Affiliation
Lotan, Chaim S.
Unknown Affiliation
Vered, Zvi
Unknown Affiliation
Zeltser, David W.
Unknown Affiliation
Zimlíchman, Reuven R.
Unknown Affiliation
Lunati, Maurizio G.
Unknown Affiliation
Ricci, Sergio
Unknown Affiliation
Stramba-Badiale, Marco
Unknown Affiliation
Terrosu, Pierfranco
Unknown Affiliation
Ong, Tiongkiam
Unknown Affiliation
Calvo, Carlos A.
Unknown Affiliation
Jerjes-Sanchez, Carlos D.
Unknown Affiliation
Gniot, Jacek R.
Unknown Affiliation
Carrageta, Manuel Oliveira
Unknown Affiliation
Panchenko, Elizaveta P.
Unknown Affiliation
Ebrahim, Iftikhar Osman
Unknown Affiliation
Klug, Eric Q.
Unknown Affiliation
Marx, Jan D.
Unknown Affiliation
Mntla, Phindile S.
Unknown Affiliation
Okreglicki, Andrzej M.
Unknown Affiliation
Pretorius, Martha M.
Unknown Affiliation
Roos, Johan S.
Unknown Affiliation
Snyders, Franci Adriaan
Unknown Affiliation
van Zyl, Louis T.
Unknown Affiliation
García-Puig, Juan
Unknown Affiliation
Viñolas, Xavier
Unknown Affiliation
Blomström, Per
Unknown Affiliation
Moccetti, Tiziano
Unknown Affiliation
Ueng, Kwo Chiang
Unknown Affiliation
Cleland, John G.F.
Unknown Affiliation
Moriarty, Andrew J.
Unknown Affiliation
Savelieva, Irina V.
Unknown Affiliation
Senior, Roxy
Unknown Affiliation
Chandrashekhar, Y. S.
Unknown Affiliation
Hunter, John J.
Unknown Affiliation
Winters, Stephen L.
Unknown Affiliation
Statistics
Citations: 1,076
Authors: 158
Affiliations: 4
Identifiers
Doi:
10.1056/NEJMoa0901301
ISSN:
00284793
Research Areas
Noncommunicable Diseases
Study Design
Cohort Study