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Stents are placed in arteries around the heart (coronary arteries) to keep formerly blocked arteries open. A blood clot (thrombus) may form in the coronary artery after stenting and cause acute myocardial infarction (fatal or non‐fatal) or more surgery. Blood thinners must be given for a short time to prevent clotting. Ticlopidine plus aspirin reduce the risk of complications after coronary stenting with less bleeding when compared to standard treatment (oral anticoagulants). Ticlopidine plus aspirin have other side effects such as bone marrow toxicity. Strict monitoring of blood‐cell counts is recommended during treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 23, 2001

Most strokes and heart attacks are caused by a blood clot blocking the blood supply to part of the brain (to cause stroke) or to the heart (to cause a heart attack). Aspirin prevents blood clots forming, and it can reduce the risk of a further heart attack or stroke in people who have had a stroke or heart attack or other symptoms of vascular disease. Clopidogrel and ticlopidine are two similar drugs called thienopyridines which prevent clots in a different way to aspirin. This review of 10 trials comparing either clopidogrel or ticlopidine with aspirin in about 27,000 people found that clopidogrel and ticlopidine were at least as effective as aspirin for the prevention of stroke and heart attacks, and might be slightly more effective. In terms of adverse effects, compared with aspirin, clopidogrel and ticlopidine caused less stomach upset and less bleeding from the gut, but more diarrhoea and skin rash. Ticlopidine produced more of these last two adverse effects than clopidogrel when compared with aspirin. Ticlopidine can also cause suppression of the bone marrow production of blood cells, which can be a serious complication. Clopidogrel is therefore the thienopyridine of choice since it is safer and better tolerated. However, since it is substantially more expensive than aspirin and not clearly more effective, it should generally only be used instead of aspirin in patients who are unable to take aspirin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 7, 2009

Patients with type 2 diabetes have a much higher risk of strokes and heart attacks than the general population. Most strokes and heart attacks are caused by blood clots. Adenosine‐diphosphate (ADP) receptor antagonists are drugs which prevent the aggregation ('clumping') of platelets and consequently reduce the formation of blood clots. These medications are used to prevent cardiovascular disease such as heart attacks and strokes in the general population. This review assessed if these medications would be useful in patients with diabetes. We included eight trials with 21,379 patients and a mean duration of follow‐up ranging from 365 to 913 days. Specific data for patients with diabetes were only available in full for one of these trials and partial data were available for two trials. Analysis of the available data demonstrated that adenosine‐diphosphate receptor antagonists (such as clopidogrel, prasugrel, ticagrelor, ticlopidine) were not more effective than other blood thinning drugs or placebo for death from any cause, death related to cardiovascular disease, heart attacks or strokes. There was no available information on the effects of adenosine‐diphosphate receptor antagonists on health‐related quality of life, adverse effects specially for people with diabetes, or costs. The use of adenosine‐diphosphate receptor antagonists in patients with diabetes needs to be guided by the information available from trials which included patients with and without diabetes. All future trials on adenosine‐diphosphate receptor antagonists should include data which relate specifically to patients with diabetes in order to inform evidence‐based clinical guidelines.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: November 14, 2012

We wanted to compare the safety and effectiveness of oral antiplatelet therapy versus placebo or no treatment in people with acute ischaemic stroke to see if oral antiplatelet drugs reduced the number of deaths and improved the long‐term outcomes in survivors.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 25, 2014

Daily aspirin reduces the incidence of heart attacks to a small degree, but increases the incidence of major bleeding events to a similar degree in patients treated for high blood pressure who have not had a prior stroke or heart attack. In patients with high blood pressure who have had a stroke or heart attack, the benefits of daily low‐dose aspirin outweigh the harms. There is no evidence of benefit for antithrombotic therapy with warfarin alone or in combination with aspirin in patients with high blood pressure. The benefits and harms of the newer drugs glycoprotein IIb/IIIa inhibitors, clopidogrel, prasugrel, ticagrelor and oral antithrombotic agents such as dabigatran and rivaroxaban for patients with high blood pressure have not been studied in clinical trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 7, 2011

Stroke is a major public health problem than can cause death and severe disability. A limited number of drugs are available for treating patients with stroke. Statins, a group of drugs commonly used to reduce cholesterol levels, are known to be safe and effective when given to patients with an acute heart attack. Therefore, they may also be beneficial in patients with acute stroke. We identified eight relevant trials of statins in acute stroke involving 625 participants. Unfortunately, insufficient information was available to establish whether statins are safe and beneficial for patients with acute ischemic stroke

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: August 10, 2011

During the last two decades, doctors have been looking for the best treatment to prevent clots in the coronary arteries of patients with coronary heart disease. This review summarises the results of 60 studies which used a potent class of intravenous antiplatelet drugs ‐ glycoprotein IIb‐IIIa blockers ‐ in 66,689 participants. This treatment was tested in two different conditions: in patients undergoing coronary angioplasty (inserting a deflated small balloon in the artery and expand it to open the vessel) with or without inserting a stent (a thin metal expandable tube or sleeve to scaffold the artery open); and as the initial treatment of patients hospitalised for unstable angina and non‐ST segment elevation acute myocardial infarction (prolonged coronary chest pain with or without small myocardial infarction). The evidence is up to date as January 2013 and the overall quality of the body of evidence was good.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: November 8, 2013

We reviewed the evidence about the effect of clopidogrel and aspirin in people at high risk of getting heart disease or having a stroke, and in those who already have heart disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 14, 2017

People with advanced kidney disease (end‐stage renal disease) need dialysis to perform kidney functions. In haemodialysis, blood is filtered through a machine. To allow a large enough passage for blood to flow between the person and the machine, an artery and a vein can be surgically joined (to form an arteriovenous fistula) or an artificial graft (a substitute for a vein) is used to join the artery to the vein. These access points might last for years but can become blocked or infected. This review investigates if additional medical therapy can keep these dialysis access points functioning.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 16, 2015

Previous studies have shown that the combination of cilostazol and aspirin may be a more effective regimen than ticlopidine plus aspirin in the prevention of late restenosis and acute or subacute stent thrombosis following coronary stenting; however, individually published results are inconclusive. The aim of this meta-analysis was to compare the differences in late restenosis and stent thrombosis between cilostazol plus aspirin and ticlopidine plus aspirin for patients with coronary heart disease (CHD) following coronary stenting. A literature search of Pubmed, Embase, Web of Science and Chinese BioMedicine (CBM) databases was conducted from 1998 to March 1, 2013 and statistical analysis was performed using Stata statistical software, version 12.0. Twelve randomized controlled trials were included in the study, with a total of 2,708 patients with CHD following coronary stenting. The patient population comprised 1,371 patients treated with cilostazol plus aspirin and 1,337 patients treated with ticlopidine plus aspirin. The meta-analysis showed that cilostazol plus aspirin demonstrated a lower rate of restenosis than ticlopidine plus aspirin [odds ratio (OR)=0.83, 95% confidence interval (CI)=0.69-0.99, P=0.047]. A significant difference was also observed in the average percent diameter stenosis between cilostazol plus aspirin and ticlopidine plus aspirin [standardized weight difference (SMD)= -0.57, 95% CI=-0.92, -0.23, P=0.001). However, there were no significant differences in the rates of acute or subacute stent thrombosis between cilostazol plus aspirin and ticlopidine plus aspirin. The present meta-analysis suggests that cilostazol plus aspirin may result in a lower restenosis rate and percent diameter stenosis than ticlopidine plus aspirin for patients with CHD following coronary stenting.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

The authors of this review found that there were no significant differences, in treatment effect or adverse events, between the use of cilostazol plus aspirin and ticlopidine plus aspirin in people undergoing elective coronary stenting. However, there was a tendency for some side-effects to be more prevalent in the ticlopidine-treated groups. The review appears to have been conducted appropriately.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

This review concluded that clopidogrel plus aspirin was more effective and had a better safety profile than ticlodipine plus aspirin in patients who had undergone coronary stenting. The review has a number of methodological limitations, which mean that the conclusions cannot be relied upon.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

BACKGROUND: Previous studies have investigated the relationship between CYP2C19 polymorphism and clinical prognosis in coronary artery disease patients treated with clopidogrel, but the results were inconsistent.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

This meta-analysis was performed to compare the risk of cardiac events and restenosis between triple antiplatelet therapy (TAT, addition of cilostazol to aspirin and clopidogrel) and conventional dual antiplatelet therapy (DAT, aspirin and clopidogrel) in drug-eluting stents (DES) implantation patients. We performed PUBMED, MEDLINE, EMBASE, and Cochrane CENTRAL searches for randomized clinical trials of TAT versus DAT in patients after DES implantation. Five clinical trials were involved in the study. TAT was associated with a 36% reduction in major adverse cardiac events (MACE; odds ratio (OR) = 0.64; 95% confidence interval (CI) = 0.51-0.81, P < .01), a 40% reduction (OR = 0.60, 95% CI = 0.44-0.80; P < .01) in target vessel revascularization (TVR), a 44% reduction (OR = 0.56, 95% CI = 0.34-0.91; P = .02) in target lesion revascularization (TLR) and a 47%/44% reduction in in-segment/in-stent restenosis (P < .01) and lower in-segment/in-stent late loss (P < .01). As regards to the safety assessment, there was no significant difference about the risk of stent thrombosis and bleeding between TAT and DAT group, while the risk of gastrointestinal trouble was significantly higher in TAT group (OR = 2.46, 95% CI = 1.25-4.86; P < .01). Addition of cilostazol to DAT reduced the incidence of MACE, TVR, and TLR after DES implantation. TAT also reduced the risk of restenosis and late loss in patients after DES implantation.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

BACKGROUND: It remains controversial whether dual antiplatelet therapy reduces stroke more than aspirin alone.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Bibliographic details: Yang LP, Xie J, Liu Y, Hu X.  Correlation between the genetic polymorphism of CYP2C19*2, *3 and the clinical efficacy of clopidogrel: a systematic review. Chinese Journal of Evidence-Based Medicine 2012; 12(9): 1063-1070 Available from: http://www.cjebm.org.cn/en/oa/DArticle.aspx?type=view&id=201209006

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

BACKGROUND AND PURPOSE: In the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, addition of clopidogrel to aspirin was associated with an unexpected increase in mortality in patients with lacunar strokes. We assessed the effect of the addition of clopidogrel to aspirin on mortality in a meta-analysis of published randomized trials.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Loss-of-function (LOF) variants of cytochrome P450 2C19 (CYP2C19) have been hypothesized to be associated with lesser degrees of platelet inhibition and increased risk for recurrent ischemic events in patients with coronary artery disease on clopidogrel therapy; however, studies from Western countries have yielded mixed results. We aimed to assess the impact of CYP2C19 LOF variants on clinical outcomes from different ethnic groups. Sixteen prospective cohort studies including 7,035 patients carrying ≥ 1 CYP2C19 LOF allele and 13,750 patients with the wild-type genotype were included in this meta-analysis. Carriers of ≥ 1 CYP2C19 LOF allele were at significantly higher risk for adverse clinical events compared to noncarriers during clopidogrel therapy (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.13 to 1.78). The summary OR showed a significant association between CYP2C19 LOF variants and an increased risk of cardiac death (OR 2.18, 95% CI 1.37 to 3.47), myocardial infarction (OR 1.42, 95% CI 1.12 to 1.81), and stent thrombosis (OR 2.41, 95% CI 1.76 to 3.30). Stratified analysis by ethnicity of study population suggested higher odds of adverse clinical events in the Asian population with LOF variants of CYP2C19 (OR 1.89, 95% CI 1.32 to 2.72) compared to Western populations (OR 1.28, 95% CI 1.00 to 1.64). In conclusion, carrier status for LOF CYP2C19 is associated with an increased risk of adverse clinical events in patients with coronary artery disease on clopidogrel therapy despite differences in clinical significance according to ethnicity.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

BACKGROUND: Published data regarding the effect of concomitant clopidogrel and proton pump inhibitor (PPI) therapy on cardiovascular outcomes have been conflicting.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

BACKGROUND: The effects of cilostazol added to aspirin and clopidogrel (triple antiplatelet therapy: TAT) on clinical outcomes after drug-eluting stent (DES) implantation are unknown.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

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