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. 2017 Dec 14;2017(12):CD005158. doi: 10.1002/14651858.CD005158.pub4

Comparison 1. Clopidogrel (Clo) plus aspirin (ASA) versus aspirin alone.

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1 Cardiovascular mortality 7 31903 Risk Ratio (M‐H, Fixed, 95% CI) 0.98 [0.88, 1.10]
1.1 Acute coronary syndrome without ST elevation 2 12648 Risk Ratio (M‐H, Fixed, 95% CI) 0.93 [0.80, 1.08]
1.2 Coronary artery bypass graft (CABG) 3 632 Risk Ratio (M‐H, Fixed, 95% CI) 0.55 [0.12, 2.57]
1.3 Ischaemic stroke 1 3020 Risk Ratio (M‐H, Fixed, 95% CI) 1.41 [0.79, 2.52]
1.4 Mixed population 1 15603 Risk Ratio (M‐H, Fixed, 95% CI) 1.04 [0.87, 1.24]
2 All‐cause mortality 9 32908 Risk Ratio (M‐H, Random, 95% CI) 1.05 [0.87, 1.25]
2.1 Acute coronary syndrome without ST elevation 1 12562 Risk Ratio (M‐H, Random, 95% CI) 0.93 [0.81, 1.07]
2.2 Ischaemic stroke 1 3020 Risk Ratio (M‐H, Random, 95% CI) 1.45 [1.10, 1.93]
2.3 CABG 4 792 Risk Ratio (M‐H, Random, 95% CI) 0.37 [0.13, 1.10]
2.4 Peripheral arterial disease (PAD) 2 931 Risk Ratio (M‐H, Random, 95% CI) 1.34 [0.74, 2.44]
2.5 Mixed population 1 15603 Risk Ratio (M‐H, Random, 95% CI) 0.99 [0.86, 1.14]
3 Fatal and non‐fatal myocardial infarction 6 16175 Risk Ratio (M‐H, Fixed, 95% CI) 0.78 [0.69, 0.90]
3.1 Acute coronary syndrome without ST elevation 1 12562 Risk Ratio (M‐H, Fixed, 95% CI) 0.78 [0.68, 0.90]
3.2 CABG 4 593 Risk Ratio (M‐H, Fixed, 95% CI) 0.89 [0.41, 1.92]
3.3 Ischaemic stroke 1 3020 Risk Ratio (M‐H, Fixed, 95% CI) 0.81 [0.51, 1.29]
4 Fatal and non‐fatal ischaemic stroke 5 4006 Risk Ratio (M‐H, Fixed, 95% CI) 0.73 [0.59, 0.91]
4.1 CABG 2 460 Risk Ratio (M‐H, Fixed, 95% CI) 0.89 [0.33, 2.40]
4.2 Ischaemic stroke 3 3546 Risk Ratio (M‐H, Fixed, 95% CI) 0.73 [0.58, 0.91]
5 Major bleeding 10 33300 Risk Ratio (M‐H, Fixed, 95% CI) 1.44 [1.25, 1.64]
5.1 Acute coronary syndrome 1 12562 Risk Ratio (M‐H, Fixed, 95% CI) 1.38 [1.13, 1.67]
5.2 CABG 4 792 Risk Ratio (M‐H, Fixed, 95% CI) 1.49 [0.69, 3.19]
5.3 PAD 2 931 Risk Ratio (M‐H, Fixed, 95% CI) 1.91 [0.69, 5.32]
5.4 Ischaemic stroke 2 3412 Risk Ratio (M‐H, Fixed, 95% CI) 1.90 [1.39, 2.60]
5.5 Mixed population 1 15603 Risk Ratio (M‐H, Fixed, 95% CI) 1.25 [0.97, 1.61]
6 Minor bleeding 8 14731 Risk Ratio (M‐H, Fixed, 95% CI) 2.03 [1.75, 2.36]
6.1 Acute coronary syndrome 1 12562 Risk Ratio (M‐H, Fixed, 95% CI) 2.08 [1.72, 2.51]
6.2 CABG 4 792 Risk Ratio (M‐H, Fixed, 95% CI) 1.54 [1.04, 2.28]
6.3 PAD 1 851 Risk Ratio (M‐H, Fixed, 95% CI) 2.20 [1.33, 3.61]
6.4 Ischaemic stroke 2 526 Risk Ratio (M‐H, Fixed, 95% CI) 2.27 [1.51, 3.39]
7 Repeated revascularization for CABG 2 413 Risk Ratio (M‐H, Fixed, 95% CI) 0.50 [0.09, 2.72]
8 Saphenous vein graft patency for CABG 3 662 Risk Ratio (M‐H, Fixed, 95% CI) 1.06 [1.01, 1.12]
9 Amputation for people with PAD 2 931 Risk Ratio (M‐H, Fixed, 95% CI) 0.68 [0.44, 1.05]
10 Sensitivity analysis ‐ random‐effects model: cardiovascular mortality 7 31903 Risk Ratio (M‐H, Random, 95% CI) 0.98 [0.88, 1.10]
10.1 Acute coronary syndrome without ST elevation 2 12648 Risk Ratio (M‐H, Random, 95% CI) 0.93 [0.80, 1.08]
10.2 CABG 3 632 Risk Ratio (M‐H, Random, 95% CI) 0.56 [0.12, 2.70]
10.3 Ischaemic stroke 1 3020 Risk Ratio (M‐H, Random, 95% CI) 1.41 [0.79, 2.52]
10.4 Mixed population 1 15603 Risk Ratio (M‐H, Random, 95% CI) 1.04 [0.87, 1.24]
11 Sensitivity analysis ‐ random‐effects model: fatal and non‐fatal myocardial infarction 6 16175 Risk Ratio (M‐H, Random, 95% CI) 0.78 [0.68, 0.89]
11.1 Acute coronary syndrome without ST elevation 1 12562 Risk Ratio (M‐H, Random, 95% CI) 0.78 [0.68, 0.90]
11.2 CABG 4 593 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.36, 1.91]
11.3 Ischaemic stroke 1 3020 Risk Ratio (M‐H, Random, 95% CI) 0.81 [0.51, 1.29]
12 Sensitivity analysis ‐ random‐effects model: fatal and non‐fatal ischaemic stroke 5 4006 Risk Ratio (M‐H, Random, 95% CI) 0.69 [0.50, 0.96]
12.1 CABG 2 460 Risk Ratio (M‐H, Random, 95% CI) 0.91 [0.33, 2.51]
12.2 Ischaemic stroke 3 3546 Risk Ratio (M‐H, Random, 95% CI) 0.63 [0.40, 1.00]
13 Sensitivity analysis ‐ random‐effects model: major bleeding 10 33300 Risk Ratio (M‐H, Random, 95% CI) 1.43 [1.25, 1.64]
13.1 Acute coronary syndrome without ST elevation 1 12562 Risk Ratio (M‐H, Random, 95% CI) 1.38 [1.13, 1.67]
13.2 CABG 4 792 Risk Ratio (M‐H, Random, 95% CI) 1.41 [0.65, 3.07]
13.3 PAD 2 931 Risk Ratio (M‐H, Random, 95% CI) 1.90 [0.68, 5.31]
13.4 Ischaemic stroke 2 3412 Risk Ratio (M‐H, Random, 95% CI) 1.89 [1.38, 2.58]
13.5 Mixed population 1 15603 Risk Ratio (M‐H, Random, 95% CI) 1.25 [0.97, 1.61]
14 Sensitivity analysis ‐ random‐effects model: minor bleeding 8 14731 Risk Ratio (M‐H, Random, 95% CI) 2.02 [1.74, 2.35]
14.1 Acute coronary syndrome without ST elevation 1 12562 Risk Ratio (M‐H, Random, 95% CI) 2.08 [1.72, 2.51]
14.2 CABG 4 792 Risk Ratio (M‐H, Random, 95% CI) 1.52 [1.01, 2.31]
14.3 PAD 1 851 Risk Ratio (M‐H, Random, 95% CI) 2.20 [1.33, 3.61]
14.4 Ischaemic stroke 2 526 Risk Ratio (M‐H, Random, 95% CI) 2.25 [1.50, 3.37]
15 Sensitivity analysis ‐ random‐effects model: repeated revascularization for people with CABG 2 413 Risk Ratio (M‐H, Random, 95% CI) 0.50 [0.09, 2.72]
16 Sensitivity analysis ‐ random‐effects model: SVG patency for people with CABG 3 662 Risk Ratio (M‐H, Random, 95% CI) 1.06 [1.01, 1.11]
17 Sensitivity analysis ‐ random‐effects model: amputation for people with PAD 2 931 Risk Ratio (M‐H, Random, 95% CI) 0.68 [0.44, 1.05]
18 Sensitivity analysis ‐ low risk of bias (RoB): cardiovascular mortality 2 12675 Risk Ratio (M‐H, Fixed, 95% CI) 0.93 [0.80, 1.07]
19 Sensitivity analysis ‐ low RoB: all‐cause mortality 3 13526 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.78, 1.20]
20 Sensitivity analysis ‐ low RoB: fatal and non‐fatal myocardial infarction 2 12675 Risk Ratio (M‐H, Fixed, 95% CI) 0.79 [0.68, 0.90]
21 Sensitivity analysis ‐ low RoB: major bleeding 4 13918 Risk Ratio (M‐H, Fixed, 95% CI) 1.41 [1.16, 1.71]
22 Sensitivity analysis ‐ low RoB: minor bleeding 4 13918 Risk Ratio (M‐H, Fixed, 95% CI) 2.09 [1.78, 2.46]