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Cochrane Nursing Care Corner: Summaries of Nursing Care–Related Systematic Reviews From the Cochrane Library: Clopidogrel Plus Aspirin Versus Aspirin Alone for Preventing Cardiovascular Disease
David Barrett RN, PgDip, PgCert, BSc (Hons)

Journal of Cardiovascular Nursing
October 2012 
Volume 27  Number 5
Pages 382 - 383
  PDF Version Available!

Is using clopidogrel in addition to standard long-term aspirin beneficial for people at risk of cardiovascular events or those with established cardiovascular disease?Cardiovascular disease-incorporating coronary, ischemic cerebrovascular, or peripheral arterial disease-remains a major cause of mortality and morbidity. Nurses have a key role in the education and support of people with or at risk of developing cardiovascular disease. It is therefore crucial for nurses to understand the risks and benefits of pharmacological interventions such as antiplatelet drugs for preventing cardiovascular disease.The review's objectives were to quantify the benefits of adding clopidogrel (a thienopyridine-derived antiplatelet) to aspirin in relation to preventing acute myocardial infarction, ischemic stroke, or vascular death in participants.1 In addition, the review sought to establish any potential harm of combined antiplatelet therapy resulting from bleeding or other adverse effects.Randomized controlled trials comparing the long-term (>30 days) use of clopidogrel plus aspirin against placebo plus aspirin, or aspirin alone, were considered. Study populations-incorporating both sexes and the complete age range-were either at high risk of atherothrombotic disease or had known coronary, ischemic cardiovascular, or peripheral arterial disease.Eleven articles reporting 2 studies (Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance [CHARISMA] and Clopidogrel in Unstable Angina to Prevent Recurrent Events [CURE]) were deemed eligible for inclusion in the review. Fifteen additional papers were inspected but excluded for a range of reasons, including a lack of clinical endpoint reporting, availability of short-term (30-day) follow-up data only, or short-term use of clopidogrel. In addition, the review reported that 5 studies in this area of practice were still ongoing. Both the selected studies were deemed as being of a high quality, with a

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