A short cut review was carried out to establish whether clopidogrel and aspirin is better than aspirin alone in improving cardiovascular outcome in patients with unstable angina. 676 papers were found using the reported searches, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that clopidogrel together with aspirin gives a better cardiovascular outcome than aspirin alone in patients with unstable angina.

Clinical scenario

A 55 year old man, known to have angina, presents to the Emergency Department with new-onset typical ischaemic rest pain that is not relieved by his nitrate spray at home. His ECG shows ST depression in V3-V6. He is haemodynamically stable. You treat him with oxygen, aspirin, nitrates, beta-blockers and heparin, after which he becomes pain free. You also give him clopidogrel 300 mg …