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(Stroke. 1999;30:1716-1721.)
© 1999 American Heart Association, Inc.

Comments, Opinions, and Reviews

Therapeutic Benefit

Aspirin Revisited in Light of the Introduction of Clopidogrel

Philip B. Gorelick, MD, FACP, MPH; Gustav V. R. Born, MB, ChB, PhD; Ralph B. D'Agostino, PhD; Daniel F. Hanley, Jr, MD; Lemuel Moye, MD, PhD Carl J. Pepine, MD

From the Center for Stroke Research, Chicago, Ill (P.B.G.); William Harvey Research Institute, London, UK (G.V.R.B.); Boston University, Boston, Mass (R.B.D.); The Johns Hopkins Hospital, Baltimore, Md (D.F.H.); The University of Texas Health Science Center, Houston, Tex (L.M.); and University of Florida College of Medicine, Gainesville, Fla (C.J.P.).

Correspondence to Philip B. Gorelick, MD, FACP, MPH, Center for Stroke Research, 1645 West Jackson Blvd, Suite 400, Chicago, IL 60612.

Background—Antiplatelet agents are widely recognized for their efficacy in reducing the occurrence of vascular events in patients with atherothrombotic disease. Aspirin is currently considered to be the "reference standard" antiplatelet agent and is recommended by the American Heart Association for use in patients with a wide range of manifestations of cardiovascular disease on the basis of its high benefit-to-risk and benefit-to-cost ratios. Recently, clopidogrel (Plavix, Bristol-Myers Squibb Co), another antiplatelet agent, was approved by the Food and Drug Administration for many of the same indications as aspirin.

Summary of Review—Because physicians will be faced with deciding whether to switch from the well-established practice of recommending aspirin for use in patients with atherothrombotic disease, both aspirin and clopidogrel are compared with respect to the primary factors that influence such decisions (ie, their relative efficacy, safety, cost, and convenience of use).

Conclusions—Based on the available evidence, aspirin is preferred for the majority of stroke or myocardial infarction patients at risk of recurrent atherothrombotic events. Clopidogrel may, however, provide valuable therapeutic benefit over aspirin in patients with peripheral arterial disease and in stroke or myocardial infarction patients for whom aspirin treatment is contraindicated or for whom aspirin fails to achieve the desired therapeutic effect.

Key Words: aspirin • clopidogrel • decision analysis • prevention

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