Researchers Say Heart Drug Is Better Than Aspirin at Preventing Heart Attacks

Scientists said that switching from aspirin to a prescription drug, clopidogrel, could reduce the risk of a heart attack, stroke, or death.

Aspirin products sit on the shelf at a Walgreens drug store in Chicago on May 26, 2004. Scott Olson/Getty Images

Researchers have said that they might have found a drug that could be better than aspirin at preventing heart attacks and long-term heart disease, according to a paper published on September 2.

In a meta-analysis published in both the British Medical Journal and The Lancet, scientists said that switching from aspirin to clopidogrel—a prescription medication used to prevent blood clots that may cause a heart attack or stroke—could reduce the risk of a heart attack, stroke, or death by an additional 14 percent in patients who suffer from coronary artery disease.

Their findings, they said, “add to the evidence that clopidogrel monotherapy is superior to aspirin monotherapy for [heart attack and stroke] prevention with no increase in the risk of bleeding, and support the preferential use of clopidogrel over aspirin for secondary prevention in patients” who have coronary artery disease.

Monday’s paper analyzed seven randomized trials that compared aspirin and clopidogrel in people with cardiovascular disease, looking at individual data. Researchers evaluated 14,507 who were assigned to clopidogrel and 14,475 assigned to aspirin.

Further, the researchers stated that clopidogrel should also “be the preferred long term antiplatelet treatment for patients” over aspirin.

A “body of evidence that has supported the long-term use of aspirin monotherapy for decades is largely based on small studies performed before the advent of modern pharmacotherapies and revascularization strategies,” they also said in the meta-analysis.

“To the best of our knowledge, clopidogrel monotherapy is the only antiplatelet treatment that has consistently demonstrated greater efficacy than aspirin without compromising safety,” the team of researchers also wrote.

For years, daily low-dose aspirin use has been touted by medical professionals and groups as a way to prevent heart attack and stroke, but that guidance was largely reversed several years ago.

The American College of Cardiology and the American Heart Association in 2019 said that aspirin should be used sparingly because it can lead to an increased risk of developing internal bleeding. An independent panel of health officials called the U.S. Preventive Services Task Force issued a similar recommendation in 2022, years after it recommended daily aspirin usage to combat cardiovascular disease.

Clopidogrel, which is often sold under the brand name Plavix, is used as a treatment following strokes or heart attacks, according to the MedicinePlus database and the Mayo Clinic. It’s sometimes used in tandem with aspirin to lower the risk of either cardiovascular event.

A database of prescription medications shows that clopidogrel is the 41st most commonly prescribed drug in the United States, with more than 15 million prescriptions written in 2023.

The AHA currently advises that patients with peripheral artery disease, which is outside either the brain or the heart, take clopidogrel over daily aspirin.

In a 2020 article, cardiologists at Johns Hopkins University, Harvard University, the Massachusetts General Hospital, and the National University of Ireland Galway wrote that more research is needed on whether aspirin should be prescribed indefinitely.

“Recent primary prevention trials have also failed to consistently demonstrate net benefit for aspirin in patients treated to optimal contemporary cardiovascular risk factor targets, indicating that the efficacy of aspirin for secondary prevention” of chronic coronary syndrome, namely in individuals who are at risk of internal bleeding caused by aspirin, “may similarly have changed with the addition of more modern secondary prevention therapies.”

“The totality of recent evidence supports further study of the universal need for lifelong aspirin in secondary prevention for all adults with [chronic coronary syndrome], particularly in stable older patients who are at highest risk for aspirin-induced bleeding,” they wrote.