Effects Of Clopidogrel In Addition To Aspirin In Patients With Acute Coronary Syndromes Without ST-Segment Elevation Associated With T2 Diabetes

Background Despite current treatment,patients who have acute coronary syndromes without ST-segment elevation associated with T 2 Diabetes have high rates of major vascular events.We evaluated the efficacy and safety of the antiplatelet agent clopidogrel when given with aspirin in those patients.Methods We randomly assigned 189 patients who had presented within 24 hours after the onset of symptoms to receive clopidogrel(300 mg immediately,followed by 75 mg once daily) (93 patients)or not to receive clopidogrel(96 patients)in addition to aspirin for 3 to 12 months. The primary outcome:a composite of death from cardiovascular causes,nonfatal myocardial infarction,stroke or refractory ischemia.The safety-related outcomes were bleeding complications,hemorrhagic stroke,severve gastroin bestinal.Results The primary outcome occurred in 6.5 percent of the patients in the treatment group and 16.7 percent of the patients in the contrast group(relative risk 0.35;95 percent confidence interval,0.13 to 0.92;P＜0.05).The percentages of patients with severe ischemia,heart failure, were also significantly lower with treatmentgroup.There were more patients with major bleeding in the treatment group than in the contrast group,but there were no significant of statistics.Conclusions The antiplatelet agent clopidogrel has beneficial effects in patients with acute coronary syndromes without ST-segment elevation associated with T2 Diabetes for relatively long-term when given with aspirin.However,there is an increas trend of the risk of major bleeding among patients treated with two antiplatelet agent- clopidogrel and aspirin.