Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation
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BACKGROUND: Despite current treatments, patients who have acute coronary syndromes without ST-segment elevation have high rates of major vascular events. We evaluated the efficacy and safety of the antiplatelet agent clopidogrel when given with aspirin in such patients. METHODS: We randomly assigned 12,562 patients who had presented within 24 hours after the onset of symptoms to receive clopidogrel (300 mg immediately, followed by 75 mg once daily) (6259 patients) or placebo (6303 patients) in addition to aspirin for 3 to 12 months. RESULTS: The first primary outcome--a composite of death from cardiovascular causes, nonfatal myocardial infarction, or stroke--occurred in 9.3 percent of the patients in the clopidogrel group and 11.4 percent of the patients in the placebo group (relative risk with clopidogrel as compared with placebo, 0.80; 95 percent confidence interval, 0.72 to 0.90; P<0.001). The second primary outcome--the first primary outcome or refractory ischemia--occurred in 16.5 percent of the patients in the clopidogrel group and 18.8 percent of the patients in the placebo group (relative risk, 0.86; 95 percent confidence interval, 0.79 to 0.94; P<0.001). The percentages of patients with in-hospital refractory or severe ischemia, heart failure, and revascularization procedures were also significantly lower with clopidogrel. There were significantly more patients with major bleeding in the clopidogrel group than in the placebo group (3.7 percent vs. 2.7 percent; relative risk, 1.38; P=0.001), but there were not significantly more patients with episodes of life-threatening bleeding (2.2 percent [corrected] vs. 1.8 percent; P=0.13) or hemorrhagic strokes (0.1 percent vs. 0.1 percent). CONCLUSIONS: The antiplatelet agent clopidogrel has beneficial effects in patients with acute coronary syndromes without ST-segment elevation. However, the risk of major bleeding is increased among patients treated with clopidogrel.
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Following acute coronary syndrome, dual antiplatelet therapy with clopidogrel and aspirin reduced the risk of myocardial infarction, stroke, and death over 8 months from 6.4% to 4.5% (P=0.03) in NSTEMI (CURE).
“and from 6.4% to 4.5% (P ¼ 0.03) over a period of 8 months in NSTEMI patients [Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE)].505”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [505]
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- Authors
- The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators
- Affiliations
- Hamilton General Hospital (CA)
- Corresponding author
- The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2001-08-16
- Volume
- 345
- Issue
- 7
- Pages
- 494-502
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W1553345686
- Cited by
- 6,470
- References
- 16
- Citations by year
- 2026: 63 · 2025: 99 · 2024: 77 · 2023: 110 · 2022: 121 · 2021: 163 · 2020: 168 · 2019: 202 · 2018: 216 · 2017: 229 · 2016: 265 · 2015: 325 · 2014: 319 · 2013: 397 · 2012: 395
- FWCI
- 178.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Repository of the Academy's Library (Library of the Hungarian Academy of Sciences) (acceptedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Keywords
- clopidogrel, aspirin, antiplatelet therapy, major bleeding, refractory ischemia, cardiovascular mortality, myocardial infarction, stroke, heart failure, revascularization
- MeSH terms
- Clopidogrel, Acute Disease, Aged, Aspirin, Cardiovascular Diseases, Drug Therapy, Combination, Electrocardiography, Female, Hemorrhage, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors, Risk Factors, Ticlopidine, Myocardial Ischemia
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