The major component in the treatment and prevention of cardiovascular diseases is antiplatelet. Traditionally aspirin has been used as a modality in the treatment and reduction of vascular events. Randomized controlled trials have been carried out to establish if adding clopidogrel has any benefits. The results of such experiments have been very conflicting. Reasons for such conflicting results have been given as, the population being heterogeneous (Nursing, 2007).
Background question
In Patients With Miocardial Infarction and Cardiovascular Events Is Aspirin Beneficial as Mono or Dual Therapy With Clopidogrel?
- P- Patients with Miocardialinfarction and Cardiovascular events
- I- Clopidogrel plus Aspirin (dual therapy)
- C- Antiplatelet Monotherapy
- O- Reduction or prevention of vascular events
- T- 8 months
Description of keywords and database used
Completed randomized controlled trials that investigated the effect of mono antiplatelet versus dual antiplatelet therapy in the prevention of vascular events in patients with vascular diseases were sought using medical subject headings and keywords related to aspirin and clopidogrel, cardiovascular disease (i.e., “unstable angina,” “ACS,” “myocardial infarction,” “stroke,” “percutaneous coronary intervention,” and “cerebrovascular disease”), and study type (i.e., “randomized controlled trial”) (White, 2008).
Appraisal
In critically appraising this article, the following factors were assessed;
Sub analysis
From the analysis we can draw conclusions that dual therapy can be used as an intervention in prevention and treatment of vascular activity by reducing the risk of major bleeding hence mortality, this is from the sub-analysis (DiCenso, 2009)
Valid clinical problem and clinical question
While discussing the validity of the problem and to what extent this article solves the matter at hand, we see that the study sticks to its objective and delivers desirable results.
Validity of the results
In assessing the validity of the results a quality scale is used where in A there is true randomization and concealed and in B randomization not given plus allocation is not clear, this methods are recommended by Cochrane collaboration (Nursing, 2007).
The study has also shed some light in measuring the study’s outcome and performance. As stated in the study that unless a definite contraindication arose then medication would continue as planned hence outcome measures. The study also does a follow-up after the treatment (Miller, 2010).
The results
In the analysis of the results of this study, we exploited such factors as the statistical methods used. Our objective is to compare the group mean value on the continuous outcome variable between or among the group as done below.
These trials randomized 91,744 patients (45,868 to dual therapy with clopidogrel and aspirin and 45,874 to antiplatelet monotherapy). 62 to 66.5 years, and the average proportion of men was 70%. There were a total of 5,033 deaths from all causes by the end of follow-up time (2,451 deaths in the combined aspirin and clopidogrel group and 2,582 in the antiplatelet monotherapy group) (Docherty, 2011).
Table
Clinical Meaningfulness is also vital in the analysis of results. The NNT is available in the study hence the ability to estimate the clinical meaning of the therapy (DiCenso, 2009).
Application of results to patients care
In trying to establish the provider’s perspective, the study does a good job in examining all the clinically important outcomes when it evaluates the primary outcome, composite vascular events. The study goes ahead to assess the efficacy of the outcomes.
Application
When looking at the application of the study, we note that using Triple antiplatelet therapy in MI is more efficient. The low cost of this modality is also recommendable thus the medication can be used in populations where medical resources are limited.
References
DiCenso, A. (2009). Evidence-Based Nursing: A guide to Clinical Practice. New York: Elsevier Health Sciences.
Docherty, B. (2011). Electronic Nursing Documentation as a strategy to Improve Quality of Patient Care. Journal of Nursing Scholarship , 154-162.
Miller, F. (2010). Evidence-Based Nursing. London: VDM Verlag.
Nursing, R. C. (2007). Evidence Based Nursing: An Examination of the role of Nursing Within International Evidence Based Health Care Movement. London: Royal College of Nursing.
White, L. (2008). Foundations of Nursing. Chicago: Cengage Learning.