New study finds clopidogrel outperforms aspirin in preventing heart attacks and strokes; here’s what experts have to say

Describing their findings in The Lancet, the researchers wrote: “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.” They added, “These results support a preference for clopidogrel over aspirin for chronic antiplatelet monotherapy for patients with stable CAD.”

The results suggest that clopidogrel should be considered the preferred long-term antiplatelet therapy for those with CAD — a condition that affects millions worldwide. Notably, the study found patients taking clopidogrel had a 14% lower risk of major cardiovascular or cerebrovascular events than those on aspirin, while the rates of major bleeding were similar.

But, what exactly is clopidogrel, and should patients already on aspirin talk to their doctors about switching medications?

Dr CM Nagesh, General Secretary, Indian College of Cardiology, tells indianexpress.com, “Clopidogrel is a medication that prevents blood clots by making platelets less sticky, thereby reducing the chances of heart attacks and strokes.”

Dr Jagadish Hiremath, a public health expert, adds that for patients already on aspirin, the key message is not to make abrupt changes without consulting a doctor. “In family practice, we often see people who have multiple health conditions, so the choice between aspirin and clopidogrel depends on their overall medical profile, tolerance, and affordability,” he notes. 

Concurring, Dr Nagesh states that aspirin still has “an important role in many treatment plans, particularly in patients who may not tolerate clopidogrel well or where it remains the recommended first option.”

For decades, millions of patients at risk of cardiovascular events have been advised to take daily low-dose aspirin, a blood thinner that can help prevent heart attacks and strokes. (Source: Freepik)

How significant is this finding for those at risk of getting heart attacks and strokes?

According to Dr Nagesh, this is an encouraging outcome because bleeding is one of the biggest safety concerns when prescribing any long-term blood thinner. He says, “If clopidogrel can offer superior protection without increasing bleeding risks, it provides physicians with greater confidence in prescribing it for long-term prevention. It also reassures patients who often worry about balancing the benefit of preventing a heart attack against the fear of a serious bleed.”

Even patients with clinical features linked to poor clopidogrel responsiveness still benefited. What does this mean for tailoring treatment to individuals?

For general practice, Dr Hiremath reveals that this is “encouraging” because it “suggests that clopidogrel could help a wide variety of patients without requiring complicated genetic or responsiveness testing before starting treatment.” If the benefits extend across groups, it simplifies prescribing at the community level where resources are limited.

However, Dr Nagesh stresses that it is important to note that these are results from a meta-analysis, and clinical guidelines usually change after multiple large-scale studies are reviewed and confirmed by global health authorities. “While the findings are promising, further real-world data and long-term studies will help confirm how widely this can be adopted.”