Tejal Somvanshi
A new study reveals that clopidogrel works better than aspirin at preventing heart attacks and strokes, potentially changing how millions of heart patients are treated worldwide.
For decades, aspirin has been the go-to medication for people with coronary artery disease (CAD). This common heart condition affects over 300 million people globally, including 2.3 million in the UK. CAD happens when arteries in the heart narrow due to fatty buildup, which can lead to heart attacks if blockages occur.
Now, research presented at the European Society of Cardiology congress in Madrid and published in the Lancet medical journal shows clopidogrel is more effective. The comprehensive analysis of nearly 29,000 patients found clopidogrel reduced the risk of serious heart and stroke events by 14% compared to aspirin.
Importantly, patients taking clopidogrel did not experience higher rates of major bleeding, which is a common concern with blood-thinning medications.
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“These findings are likely to impact the medications doctors prescribe to their patients to reduce their risk of future heart problems,” said Professor Bryan Williams, chief scientific and medical officer at the British Heart Foundation.
The international research team, which included experts from the US, UK, Australia, Switzerland, and Japan, called the results “superior” to aspirin and suggested clopidogrel should lead to “extensive adoption” in clinical practice worldwide.
This discovery challenges long-standing medical guidelines. Aspirin has traditionally been prescribed indefinitely for CAD patients, but the evidence supporting its long-term benefits has been limited.
Even patients who might respond less effectively to clopidogrel due to genetic or clinical factors still benefited more from it than from aspirin. This suggests clopidogrel could help a broad range of patients with coronary artery disease.
The findings align with other recent research. At the American College of Cardiology conference in March 2025, the SMART-CHOICE 3 trial showed that high-risk patients who had undergone procedures to unclog arteries were 29% less likely to experience death, heart attack, or stroke when taking clopidogrel compared to aspirin.
Both medications are widely available as affordable generic drugs. In the UK, generic clopidogrel costs roughly 3.6 pence per day, while aspirin costs about 2.5 pence per day.
Despite the promising results, medical experts caution that patients should not switch medications without consulting their doctors. Treatment decisions should be individualized based on each patient’s specific health situation. As more evidence accumulates showing clopidogrel’s advantages, medical organizations will likely review their guidelines.
