Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes - Observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study

Ron J. G. Peters; Shamir R. Mehta; Keith A. A. Fox; Feng Zhao; Basil S. Lewis; Steven L. Kopecky; Rafael Diaz; Patrick J. Commerford; Vicent Valentin; Salim Yusuf

doi:10.1161/01.CIR.0000091201.39590.CB

Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes - Observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study

Ron J. G. Peters
, Shamir R. Mehta
, Keith A. A. Fox
, Feng Zhao
, Basil S. Lewis
, Steven L. Kopecky
, Rafael Diaz
, Patrick J. Commerford
, Vicent Valentin
, Salim Yusuf

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background-We studied the benefits and risks of adding clopidogrel to different doses of aspirin in the treatment of patients with acute coronary syndrome (ACS). Methods and Results-In the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial, 12 562 patients with ACS using aspirin, 75 to 325 mg daily, were randomized to clopidogrel or placebo for up to 1 year. In this analysis, patients were divided into the following 3 aspirin dose groups: less than or equal to100 mg, 101 through 199 mg, and greater than or equal to200 mg. The combined incidence of cardiovascular death, myocardial infarction, or stroke was reduced by clopidogrel regardless of aspirin dose, as follows: less than or equal to100 mg, 10.5% versus 8.6% (relative risk [RR], 0.81 [95% CI, 0.68 to 0.97]); 101 to 199 mg, 9.8% versus 9.5% (RR, 0.97 [95% CI 0.77 to 1.22]); and greater than or equal to200 mg, 13.6% versus 9.8% (RR, 0.71 [95% CI, 0.59 to 0.85]). The incidence of major bleeding increased with increasing aspirin dose both in the placebo group (1.9%, 2.8%, and 3.7%, respectively; P=0.0001) and the clopidogrel group (3.0%, 3.4%, and 4.9%, respectively; P=0.0009); thus, the excess risk with clopidogrel was 1.1%, 1.2%, and 1.2%, respectively. The adjusted hazard ratio for major bleeding for the highest versus the lowest dose of aspirin was 1.9 (95% CI 1.29 to 2.72) in the placebo group, 1.6 (95% CI 1.19 to 2.23) in the clopidogrel group, and 1.7 (95% CI 1.36 to 2.20) in the combined group. Conclusions-In patients with ACS, adding clopidogrel to aspirin is beneficial regardless of aspirin dose. Bleeding risks increase with increasing aspirin dose, with or without clopidogrel, without any increase in efficacy. Our findings suggest that the optimal daily dose of aspirin may be between 75 and 100 mg, with or without clopidogrel

Original language	English
Pages (from-to)	1682-1687
Journal	Circulation
Volume	108
Issue number	14
DOIs	https://doi.org/10.1161/01.CIR.0000091201.39590.CB
Publication status	Published - 2003

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Peters, R. J. G., Mehta, S. R., Fox, K. A. A., Zhao, F., Lewis, B. S., Kopecky, S. L., Diaz, R., Commerford, P. J., Valentin, V., & Yusuf, S. (2003). Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes - Observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation, 108(14), 1682-1687. https://doi.org/10.1161/01.CIR.0000091201.39590.CB

@article{d7370b39e29b41d48b4d0e92ec586f6c,

title = "Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes - Observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study",

abstract = "Background-We studied the benefits and risks of adding clopidogrel to different doses of aspirin in the treatment of patients with acute coronary syndrome (ACS). Methods and Results-In the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial, 12 562 patients with ACS using aspirin, 75 to 325 mg daily, were randomized to clopidogrel or placebo for up to 1 year. In this analysis, patients were divided into the following 3 aspirin dose groups: less than or equal to100 mg, 101 through 199 mg, and greater than or equal to200 mg. The combined incidence of cardiovascular death, myocardial infarction, or stroke was reduced by clopidogrel regardless of aspirin dose, as follows: less than or equal to100 mg, 10.5\% versus 8.6\% (relative risk [RR], 0.81 [95\% CI, 0.68 to 0.97]); 101 to 199 mg, 9.8\% versus 9.5\% (RR, 0.97 [95\% CI 0.77 to 1.22]); and greater than or equal to200 mg, 13.6\% versus 9.8\% (RR, 0.71 [95\% CI, 0.59 to 0.85]). The incidence of major bleeding increased with increasing aspirin dose both in the placebo group (1.9\%, 2.8\%, and 3.7\%, respectively; P=0.0001) and the clopidogrel group (3.0\%, 3.4\%, and 4.9\%, respectively; P=0.0009); thus, the excess risk with clopidogrel was 1.1\%, 1.2\%, and 1.2\%, respectively. The adjusted hazard ratio for major bleeding for the highest versus the lowest dose of aspirin was 1.9 (95\% CI 1.29 to 2.72) in the placebo group, 1.6 (95\% CI 1.19 to 2.23) in the clopidogrel group, and 1.7 (95\% CI 1.36 to 2.20) in the combined group. Conclusions-In patients with ACS, adding clopidogrel to aspirin is beneficial regardless of aspirin dose. Bleeding risks increase with increasing aspirin dose, with or without clopidogrel, without any increase in efficacy. Our findings suggest that the optimal daily dose of aspirin may be between 75 and 100 mg, with or without clopidogrel",

author = "Peters, \{Ron J. G.\} and Mehta, \{Shamir R.\} and Fox, \{Keith A. A.\} and Feng Zhao and Lewis, \{Basil S.\} and Kopecky, \{Steven L.\} and Rafael Diaz and Commerford, \{Patrick J.\} and Vicent Valentin and Salim Yusuf",

year = "2003",

doi = "10.1161/01.CIR.0000091201.39590.CB",

language = "English",

volume = "108",

pages = "1682--1687",

journal = "Circulation",

issn = "0009-7322",

publisher = "Lippincott Williams and Wilkins",

number = "14",

}

Peters, RJG, Mehta, SR, Fox, KAA, Zhao, F, Lewis, BS, Kopecky, SL, Diaz, R, Commerford, PJ, Valentin, V & Yusuf, S 2003, 'Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes - Observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study', Circulation, vol. 108, no. 14, pp. 1682-1687. https://doi.org/10.1161/01.CIR.0000091201.39590.CB

Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes - Observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. / Peters, Ron J. G.; Mehta, Shamir R.; Fox, Keith A. A. et al.
In: Circulation, Vol. 108, No. 14, 2003, p. 1682-1687.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes - Observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study

AU - Peters, Ron J. G.

AU - Mehta, Shamir R.

AU - Fox, Keith A. A.

AU - Zhao, Feng

AU - Lewis, Basil S.

AU - Kopecky, Steven L.

AU - Diaz, Rafael

AU - Commerford, Patrick J.

AU - Valentin, Vicent

AU - Yusuf, Salim

PY - 2003

Y1 - 2003

N2 - Background-We studied the benefits and risks of adding clopidogrel to different doses of aspirin in the treatment of patients with acute coronary syndrome (ACS). Methods and Results-In the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial, 12 562 patients with ACS using aspirin, 75 to 325 mg daily, were randomized to clopidogrel or placebo for up to 1 year. In this analysis, patients were divided into the following 3 aspirin dose groups: less than or equal to100 mg, 101 through 199 mg, and greater than or equal to200 mg. The combined incidence of cardiovascular death, myocardial infarction, or stroke was reduced by clopidogrel regardless of aspirin dose, as follows: less than or equal to100 mg, 10.5% versus 8.6% (relative risk [RR], 0.81 [95% CI, 0.68 to 0.97]); 101 to 199 mg, 9.8% versus 9.5% (RR, 0.97 [95% CI 0.77 to 1.22]); and greater than or equal to200 mg, 13.6% versus 9.8% (RR, 0.71 [95% CI, 0.59 to 0.85]). The incidence of major bleeding increased with increasing aspirin dose both in the placebo group (1.9%, 2.8%, and 3.7%, respectively; P=0.0001) and the clopidogrel group (3.0%, 3.4%, and 4.9%, respectively; P=0.0009); thus, the excess risk with clopidogrel was 1.1%, 1.2%, and 1.2%, respectively. The adjusted hazard ratio for major bleeding for the highest versus the lowest dose of aspirin was 1.9 (95% CI 1.29 to 2.72) in the placebo group, 1.6 (95% CI 1.19 to 2.23) in the clopidogrel group, and 1.7 (95% CI 1.36 to 2.20) in the combined group. Conclusions-In patients with ACS, adding clopidogrel to aspirin is beneficial regardless of aspirin dose. Bleeding risks increase with increasing aspirin dose, with or without clopidogrel, without any increase in efficacy. Our findings suggest that the optimal daily dose of aspirin may be between 75 and 100 mg, with or without clopidogrel

AB - Background-We studied the benefits and risks of adding clopidogrel to different doses of aspirin in the treatment of patients with acute coronary syndrome (ACS). Methods and Results-In the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial, 12 562 patients with ACS using aspirin, 75 to 325 mg daily, were randomized to clopidogrel or placebo for up to 1 year. In this analysis, patients were divided into the following 3 aspirin dose groups: less than or equal to100 mg, 101 through 199 mg, and greater than or equal to200 mg. The combined incidence of cardiovascular death, myocardial infarction, or stroke was reduced by clopidogrel regardless of aspirin dose, as follows: less than or equal to100 mg, 10.5% versus 8.6% (relative risk [RR], 0.81 [95% CI, 0.68 to 0.97]); 101 to 199 mg, 9.8% versus 9.5% (RR, 0.97 [95% CI 0.77 to 1.22]); and greater than or equal to200 mg, 13.6% versus 9.8% (RR, 0.71 [95% CI, 0.59 to 0.85]). The incidence of major bleeding increased with increasing aspirin dose both in the placebo group (1.9%, 2.8%, and 3.7%, respectively; P=0.0001) and the clopidogrel group (3.0%, 3.4%, and 4.9%, respectively; P=0.0009); thus, the excess risk with clopidogrel was 1.1%, 1.2%, and 1.2%, respectively. The adjusted hazard ratio for major bleeding for the highest versus the lowest dose of aspirin was 1.9 (95% CI 1.29 to 2.72) in the placebo group, 1.6 (95% CI 1.19 to 2.23) in the clopidogrel group, and 1.7 (95% CI 1.36 to 2.20) in the combined group. Conclusions-In patients with ACS, adding clopidogrel to aspirin is beneficial regardless of aspirin dose. Bleeding risks increase with increasing aspirin dose, with or without clopidogrel, without any increase in efficacy. Our findings suggest that the optimal daily dose of aspirin may be between 75 and 100 mg, with or without clopidogrel

U2 - 10.1161/01.CIR.0000091201.39590.CB

DO - 10.1161/01.CIR.0000091201.39590.CB

M3 - Article

C2 - 14504182

SN - 0009-7322

VL - 108

SP - 1682

EP - 1687

JO - Circulation

JF - Circulation

IS - 14

ER -