Impact of Clopidogrel Therapy on Mortality and Cancer in Patients With Cardiovascular and Cerebrovascular Disease: A Patient-Level Meta-Analysis

Circulation. Cardiovascular Interventions
Sammy ElmariahLaura Mauri

Abstract

Clinical trial data associate extended clopidogrel therapy with increased mortality and cancer. We sought to determine the impact of continued clopidogrel use on mortality and cancer within a patient-level meta-analysis of randomized clinical trials. Meta-analytic clinical event rates for all-cause, cardiovascular, noncardiovascular, and cancer-related mortality; cancer; myocardial infarction; stroke; and fatal and major nonfatal bleeding were generated using patient-level data from 6 randomized trials comparing prolonged versus no or short-duration clopidogrel on a background of aspirin in patients with cardiovascular and cerebrovascular disease. Among 48 817 randomized patients (median follow-up 546 days), there was no difference in all-cause (7.23% versus 7.26%; P=0.97), cardiovascular (5.25% versus 5.22%; P=0.86), noncardiovascular (1.98% versus 2.03%; P=0.73), and cancer-related (0.93% versus 0.99%; P=0.59) mortality or in new cancer diagnoses (2.97% versus 2.96%; P>0.99). Rates of myocardial infarction (3.21% versus 4.05%; P<0.0001) and stroke (3.04% versus 3.75%; P<0.0001) were significantly lower in patients receiving continued clopidogrel. Fatal bleeding was more common with continued clopidogrel use (0.39% versus 0.27...Continue Reading

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Sep 3, 2019·The New England Journal of Medicine·P Gabriel StegUNKNOWN THEMIS Steering Committee and Investigators
Oct 28, 2019·Cancers·Corinne FrereUNKNOWN Groupe Francophone Thrombose et Cancer
Jan 19, 2019·European Heart Journal. Cardiovascular Pharmacotherapy·Christoph C KaufmannKurt Huber
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Jun 25, 2021·Frontiers in Cardiovascular Medicine·Moez Karim AzizCezar A Iliescu
Jul 29, 2021·Cardiovascular Drugs and Therapy·Xiaohua LiXia Cao
Apr 13, 2021·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Raffaele PiccoloPeter Jüni

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