Clopidogrel may be preferred over aspirin to reduce cardiovascular risk in patients with human immunodeficiency virus (HIV), according to research presented at the International Society on Thrombosis and Haemostasis (ISTH) 2021 annual congress.

Patients with HIV are at a higher risk of developed cardiovascular disease. Aspirin and clopidogrel are common antiplatelet medications used to reduce the risk of heart disease.

The randomized controlled trial compared clopidogrel to aspirin. A total of 22 patients received clopidogrel, 22 received aspirin, and 11 received no treatment for 14 days. The researchers isolated platelets from 6 patients (2 from each group) in human umbilical vein endothelial cells (HUVECs) to assess proinflammatory HUVEC gene expression.

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Aspirin reduced platelet aggregation to arachidonic acid (AA) significantly compared with clopidogrel (84% vs. 31%, P <.01). Clopidogrel reduced platelet aggregation to adenosine diphosphate (ADP) compared with aspirin (85% vs. 41%, P <.0001).

Clopidogrel reduced platelet activation when compared to aspirin, and reduced HUVEC proinflammatory gene expression when compared with no treatment. Platelets of patients treated with aspirin upregulated HUVEC gene expression.

The researchers concluded that clopidogrel may be a preferable treatment to lower the risk of cardiovascular disease in patients with HIV. However, larger studies are needed.


Schwartz T, Maracantoni E, Allen N, et al. Platelet activity and platelet-induced endothelial inflammatory pathways in treated HIV is lowered by clopidogrel: a randomized control trial. Paper presented at: International Society on Thrombosis and Haemostasis (ISTH) 2021 Congress; July 17-21, 2021; virtual. Abstract PB0978.