Compared with ASA, long-term antiplatelet monotherapy with clopidogrel in patients with symptomatic PAD has an additional benefit with regard to the risk reduction for vascular/thromboembolic events. No such evidence is available with regard to the reduction of overall mortality. In patients with IHD or ICVD (in each case without co-existing symptomatic PAD), an additional benefit of clopidogrel therapy has not been demonstrated.
There is no evidence available that the above conclusions differ for specific patient groups with an increased risk of thromboembolic events (e.g. patients with hypercholesterolaemia, diabetes mellitus, or manifestations of atherosclerosis in more than 1 vascular territory).
There is no evidence available that in patients who experienced a gastrointestinal complication (symptomatic ulcers/erosions) under ASA, a switch of therapy to clopidogrel results in a patient-relevant additional benefit. In patients with prior gastrointestinal ulcer bleeding under ASA, indications exist that a continuation of treatment with lower-dose ASA combination therapy plus a PPI (esomeprazole) results in a higher patient-relevant benefit than a switch to clopidogrel.
There is no evidence available that in patients who experienced a vascular event under ASA, a switch to clopidogrel therapy results in an additional patient-relevant benefit.