- Question
- Does adding clopidogrel to aspirin improve clinical outcomes in patients with acute coronary syndromes without ST-segment elevation?
- Design
- Randomized, placebo-controlled trial in which 12562 patients were assigned to clopidogrel or placebo on top of aspirin for 3 to 12 months.
- Population
- Patients with acute coronary syndrome without ST-segment elevation who presented within 24 hours of symptom onset.
- Intervention
- Clopidogrel with a 300 mg loading dose followed by 75 mg once daily, added to aspirin (6259 patients).
- Control
- Placebo added to aspirin (6303 patients).
- Primary outcome
- The first primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, or stroke. The second primary outcome added refractory ischemia to the first.
- Results
- The first primary outcome occurred in 9.3% with clopidogrel and 11.4% with placebo (relative risk 0.80; 95% CI, 0.72 to 0.90; P<0.001). The second primary outcome occurred in 16.5% and 18.8%, respectively (relative risk 0.86; 95% CI, 0.79 to 0.94; P<0.001).
- Safety
- Major bleeding was more frequent with clopidogrel (3.7% vs. 2.7%; relative risk 1.38; P=0.001). Life-threatening bleeding (P=0.13) and hemorrhagic stroke did not differ significantly.
- Conclusion
- Adding clopidogrel to aspirin reduces major vascular events in patients with non-ST-elevation acute coronary syndrome, at the cost of more major bleeding.
- Why it matters
- It established dual antiplatelet therapy with clopidogrel and aspirin as a cornerstone of treatment for non-ST-elevation acute coronary syndromes, accepting the trade-off between ischemic benefit and higher bleeding risk.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026