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Episode 66: A clot, a clot, I want it not – secondary prevention with antiplatelets

In episode 66, we embark on a journey of epic proportions; at least relative to our understanding.  With the help of Peter Loewen, we outline the anti-platelet options in secondary prevention of heart disease.  We discuss at length the use ASA and clopidogrel but also touch on additional agents like warfarin, dipyridamole and others.  Where the evidence is clear, we create opacity and where it is gray, we go dark. Both Mike and Peter end up in a quagmire and James offers them help by throwing them a string of one-liners and a bottle of low-dose ASA.

Show Notes

Secondary prevention with antiplatelets

1) ATTC Meta-analysis – aspirin in primary and secondary resistance

Lancet 2009;373:1849–60

2) CURE trial – clopidogrel added to aspirin

NEJM 2001;345:494-502

3) Anti-platelets in patients with a history of vascular disease or other predisposing condition – absolute benefit – 3.6% over 2 years (combined CVD events)

BMJ 2002;324:71-86

4) Low-dose aspirin – absolute benefit – around 3.3% combined CVD events and 1.5% mortality over 3 yrs

Am J Med 2008;121:43-9

5) CHARISMA – Clopidogrel and aspirin vs aspirin

N Engl J Med 2006; 354:1706-17

6) Half of the benefit of clopidogrel occurs in the first month of use Clopidogrel for the treatment of adult patients following acute coronary syndrome

Therapeutics Initiative Review

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