1. Impact of Clopidogrel Therapy on Mortality and Cancer in Patients With Cardiovascular and Cerebrovascular Disease: A Patient-Level Meta-Analysis.
- Author
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Elmariah S, Doros G, Benavente OR, Bhatt DL, Connolly SJ, Yusuf S, Steinhubl SR, Liu Y, Hsieh WH, Yeh RW, and Mauri L
- Subjects
- Aged, Aged, 80 and over, Aspirin therapeutic use, Cause of Death, Clopidogrel adverse effects, Drug Therapy, Combination, Female, Hemorrhage chemically induced, Hemorrhage mortality, Humans, Incidence, Male, Middle Aged, Myocardial Infarction blood, Myocardial Infarction diagnosis, Neoplasms blood, Neoplasms diagnosis, Platelet Aggregation Inhibitors adverse effects, Randomized Controlled Trials as Topic, Risk Assessment, Risk Factors, Stroke blood, Stroke diagnosis, Time Factors, Treatment Outcome, Clopidogrel therapeutic use, Myocardial Infarction mortality, Myocardial Infarction prevention & control, Neoplasms mortality, Platelet Aggregation Inhibitors therapeutic use, Stroke mortality, Stroke prevention & control
- Abstract
Background: Clinical trial data associate extended clopidogrel therapy with increased mortality and cancer. We sought to determine the impact of continued clopidogrel use on mortality and cancer within a patient-level meta-analysis of randomized clinical trials., Methods and Results: Meta-analytic clinical event rates for all-cause, cardiovascular, noncardiovascular, and cancer-related mortality; cancer; myocardial infarction; stroke; and fatal and major nonfatal bleeding were generated using patient-level data from 6 randomized trials comparing prolonged versus no or short-duration clopidogrel on a background of aspirin in patients with cardiovascular and cerebrovascular disease. Among 48 817 randomized patients (median follow-up 546 days), there was no difference in all-cause (7.23% versus 7.26%; P =0.97), cardiovascular (5.25% versus 5.22%; P =0.86), noncardiovascular (1.98% versus 2.03%; P =0.73), and cancer-related (0.93% versus 0.99%; P =0.59) mortality or in new cancer diagnoses (2.97% versus 2.96%; P >0.99). Rates of myocardial infarction (3.21% versus 4.05%; P <0.0001) and stroke (3.04% versus 3.75%; P <0.0001) were significantly lower in patients receiving continued clopidogrel. Fatal bleeding was more common with continued clopidogrel use (0.39% versus 0.27%; P =0.03), as were major nonfatal bleeding (4.06% versus 2.68%; P <0.0001) and intracranial hemorrhage (0.43% versus 0.30%; P =0.02)., Conclusions: Across trials of cardiovascular and cerebrovascular disease, extended-duration clopidogrel on a background of aspirin has no overall effect on mortality or cancer but does reduce rates of myocardial infarction and stroke and increase rates of bleeding. These findings emphasize the need for selective use of extended clopidogrel therapy in patients in whom the risks of ischemia are not fully counterbalanced by the risks of bleeding., (© 2018 American Heart Association, Inc.)
- Published
- 2018
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