Clopidogrel is associated with a 14% lower risk of secondary coronary artery disease compared with aspirin without raising the risk of bleeds, a major study in The Lancet has found.

The systematic review and meta-analysis used data from seven randomised trials, involving nearly 29,000 patients in total, to compare the drugs’ effect on MI, stroke and cardiovascular death risk.

The patients had established coronary artery disease (CAD) and were receiving either aspirin or clopidogrel monotherapy, having discontinued or never started dual antiplatelet therapy.

Clopidogrel was 14% better at preventing major cardiovascular or cerebrovascular events at 5.5 years, the multinational research team said, adding that clopidogrel was not associated with an elevated risk of major bleeding compared with aspirin.