Randomized Placebo Controlled Trial

This article seeks to appraise the article Addition of clopidogrel to aspirin in 45 852 patients with : . This is for the simple reason that in the recent past, numerous modalities have been used for the treatment of myocardial infarction (MI) and others are still in the pipeline being established. Looking at the background, platelet activation and aggregation can be ; these two rises during myocardial infarction. Aspirin has proved to be effective in the reduction of mortality. Clopidogrel has proven effective enough to deal with ischemic events (Docherty, 2011).

Clinical question and PICOT related to the problem
In Patients With Myocardial Infarction Is Aspirin Beneficial When Used Alone or in Addition to Clopidogrel?

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Randomized Placebo Controlled Trial
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P- Patients with Myocardial infarction
I- Aspirin
C- Clopidogrel plus Aspirin
O- Reduction or prevention of myocardial infarction events
T- 28 days
Keywords used and the database system
Headings and words used were closely related to clopidogrel and aspirin, myocardial infarction, mortality, major morbidity, stroke and study type (i.e., ). All were searched in databases like Cochrane library and MEDLINE (White, 2008).

In critically appraising this article, the following factors were assessed and how the article addresses them.

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
The article that they pursue a 2 by 2 factorial design and randomization was used in the allocation of clopidogrel 75 mg daily (n=22 961) or matching placebo (n=22 891) in addition to aspirin 162 mg daily. There was also the use of sealed study treatments (Nursing, 2007).

The study has also shed some light in measuring the studys outcome and performance, in doing so, the study ensured that there was a 4-week calendar that was followed to the letter except in arising medical situations. 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: this is done through a form which is filled and contains details on compliance, effects of the therapy either positive or negative, clinical events, death if it occurred. Also noticeable is that the study did not conduct any post-discharge follow-up. Hence, this study falls deficient in that regard and has failed to address sufficiently the complete follow-up which is vital to any patients recovery.


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