Study of 29,000 patients finds clopidogrel more effective than aspirin at preventing heart attacks
Doctors have discovered that clopidogrel, a widely prescribed blood thinner, is more effective than aspirin at preventing heart attacks and strokes — a finding that could transform global health guidelines.
For decades, millions of people living with coronary artery disease (CAD) have been advised to take daily low-dose aspirin. The drug thins the blood, making it less sticky, and reduces the risk of heart attacks and strokes. But new international research suggests that aspirin may no longer be the gold standard.
Presented at the European Society of Cardiology congress in Madrid and published in The Lancet, the study analysed data from nearly 29,000 patients with CAD. The results showed that those taking clopidogrel had a 14% lower risk of major adverse cardiovascular or cerebrovascular events — such as heart attack, stroke, or cardiovascular death — compared with those taking aspirin.
Crucially, the rates of serious bleeding were almost identical between the two groups, quashing long-standing concerns that clopidogrel might carry a higher risk of dangerous side effects.
Embed from Getty Images“This comprehensive synthesis of available evidence indicates that, in patients with CAD, long-term clopidogrel monotherapy offers superior protection against major cardiovascular and cerebrovascular events compared with aspirin, without an excess risk of bleeding,” the authors wrote in The Lancet.
The research drew on clinical trials from across the world, including the US, UK, Australia, Switzerland, and Japan. Patients studied included those who had suffered acute coronary syndrome or undergone procedures such as stent placement. The benefits of clopidogrel were consistent across all groups, even among those who might typically respond less well due to genetic or clinical factors.
Coronary artery disease remains the most common form of heart disease globally, with more than 300 million people affected. In the UK alone, around 2.3 million people live with the condition. CAD occurs when arteries supplying the heart become narrowed by fatty deposits, leading to angina and, in severe cases, heart attacks. Preventing such events often requires lifelong treatment.
Until now, aspirin has been prescribed almost universally as long-term therapy. But the evidence supporting its benefits has always been relatively limited, and experts say these new findings could upend decades of convention.
Professor Bryan Williams, chief scientific and medical officer at the British Heart Foundation, said the study could change how doctors treat patients. “Aspirin is a commonly prescribed drug to help prevent repeat heart attacks and strokes. This research suggests that clopidogrel, an alternative to aspirin, might be more effective at preventing recurrent heart attack or stroke. Importantly, these benefits come without a greater risk of major bleeding.”
Beyond effectiveness, cost and access are also critical. Clopidogrel is already available in generic form, making it affordable and accessible worldwide. That affordability, coupled with its proven efficacy, means it could be widely adopted into clinical practice.
Health policymakers are now expected to review guidelines in light of the findings. If clopidogrel replaces aspirin as the preferred treatment for CAD, the change could improve outcomes for millions of patients worldwide and save countless lives.
The researchers caution, however, that further studies are needed to explore the long-term cost-effectiveness of clopidogrel and to confirm its benefits in broader patient populations. Still, the evidence already points to a new era in cardiovascular treatment — one in which aspirin, long regarded as indispensable, may finally give way