Table 6.

—[Sections 3.2.1-3.2.5] Clopidogrel vs Aspirin for Patients With Recent ACS²⁹

Outcomes	Participants (Studies), Follow-up	Quality of the Evidence (GRADE)	Relative Effect (95% CI)	Anticipated Absolute Effects Over 1 y
				Risk With Aspirin	Difference With Clopidogrel (95% CI)
Vascular mortalitya	19,185 (1 RCT), 1.9 y	Moderate due to imprecisionb	RR 0.92 (0.80-1.07)	60 per 1,000c	No significant difference; 5 fewer per 1,000 (from 12 fewer  to 4 more)
MI nonfatal events	19,185 (1 RCT), 1.9 y	Moderate due to imprecisionb	RR 0.85 (0.72-1.00)	70 per 1,000c	10 fewer per 1,000 (from 20 fewer to 0 more)
Stroke includes nonfatal ischemic and hemorrhagic strokesd	19,185 (1 RCT), 1.9 y	High	RR 0.94 (0.83-1.06)	20 per 1,000c	No significant difference; 1 fewer per 1,000 (from 3 fewer  to 1 more)
Major extracranial bleede	19,185 (1 RCT), 1.9 y	Highf	RR 0.88 (0.7-1.12)	30 per 1,000c	No significant difference; 3 fewer per 1,000 (from 9 fewer  to 3 more)

See Table 1-3 legends for expansion of abbreviations.

^aOf the deaths in CAPRIE 27 of 405 (6.7%) with aspirin were fatal bleeding events, and 23 of 372 (6.2%) with clopidogrel were fatal bleeding events.

^bRated down for imprecision for MI because of a wide CI, including important benefit and no benefit with clopidogrel.

^cControl group risk estimates for death, MI, stroke, and bleeding come from the CURE trial (adjusted to 1-y time frame).

^dOf the strokes in CAPRIE, 24 of 486 (4.9%) with aspirin were hemorrhagic, and 14 of 528 (2.6%) with clopidogrel were hemorrhagic.

^eOf the major extracranial bleeds in CAPRIE, 68 of 149 (45.6%) with aspirin were GI, and 47 of 132 (35.6%) with clopidogrel were GI.

^fOur decision not to rate down for imprecision is due to the low control group risk for strokes and major bleeds that result in no important harm of clopidogrel (as judged by the upper limit of the 95% CI for the absolute effect).