Clopidogrel vs Aspirin for Secondary Prevention of CAD: AKT Summary and Analysis

Published by: RCGP Hot Topics (August 2025)

Original Source: The Lancet, July 2025 – IPD Meta-analysis (n = 28,982)

The RCGP Hot Topics summary explores the key findings from a major 2025 Lancet meta-analysis comparing clopidogrel vs aspirin for secondary prevention in coronary artery disease (CAD). This represents the most robust evidence to date on this topic and may shift long-standing prescribing practices in UK primary care.

At A4Medicine, we've reviewed and simplified the analysis to focus on:

• Key evidence GPs need to know

• AKT-relevant statistics and caveats

• Practical implications for real-world decision-making

Key Clinical Evidence Analysis

Study Design:
Individual Patient Data (IPD) meta-analysis of 7 RCTs (n = 28,982) – Lancet, 2025.

Main Finding:
Clopidogrel monotherapy is superior to aspirin for secondary prevention in established coronary artery disease (CAD), with:

• ↓14% relative risk of major adverse cardiac and cerebrovascular events (MACCE)
  → HR 0.86; p = 0.0082

• No ↑ in major bleeding risk

🧾 Implication: Challenges the traditional "aspirin-first" approach in stable CAD post-DAPT.

Clinical Outcomes: Clopidogrel vs Aspirin for Secondary Prevention of CAD (events per 100 patient-years)