Is clopidogrel better than aspirin? An unclear choice

http://www.lawyersandsettlements.com/lawsuit/plavix.html#.Ui2YwLIaNW0


The issue with antiplatelet therapy is huge because a lot of patients are treated by these drugs and by the fact a lot of them do have side effects or inefficacy.
1/ one or two?
Despite the answer to this question by CHARISMA trial a dual antiplatelet is still prescribed to patients who are not bearing DES or are at high risk of arterial thrombosis.
So except for DES or a short period (usually 3 months) after implanting long bare stents there is no indication to prescribe a dual antiplatelet therapy because the risks outweigh the benefits.

2/ Efficacy
A lot of studies emphasized that either aspirin or clopidogrel could be inefficient in a patient for several reasons:
- genetics
- other drugs
- thrombophilia
- high risk profile of metabolic markers (D2, high Lpa, high TG...).
The solution is not to prescribe the two drugs in case...
In order to identify the precise reason of inefficacy one must prescribe in Vitro tests like platelet aggregation, platelet filtration sensitized by platelet activators or drugs. Those tests could be completed by a genetic analysis of CYP2 genes.

3/ Side effects

The major side effect of antiplatelet therapy is bleeding or ecchymosis or a hematomas. These side effects could be fretful especially for G.I. bleeding or intracranial hemorrage. There is no convincing data in favor of either aspirin or clopidogrel according to the risk of bleeding.
One must be aware of the risk of less efficiency of clopidogrel a prodrug with H+ pump inhibitors.