Based on the available evidence, we can demonstrate a small, statistically
non-significant beneficial effect of adding clopidogrel to
long-term administration of aspirin, but a significantly increased
risk of bleeding, in people at high risk of atherothrombotic disease
without evidence of cardiovascular disease, and in people with
evidence of cardiovascular disease. In acute coronary syndrome
the picture is clearer, with evidence of benefits outweighing major
bleeding events.However, it is unclearwhether the beneficial effect
is largely due to early post-acute event combination therapy and
is smaller in the long term. Future studies will provide additional
data to assess whether specific subgroups (most notably patients
with coronary disease who have undergone percutaneous coronary
intervention) may benefit from long-term combined antiplatelet
therapy with clopidogrel and aspirin.