Clopidogrel vs. Aspirin for Cardiovascular Risk Reduction in Patients With S. Aureus Bacteremia

This is an open-label randomized controlled trial which will enroll patients with S. aureus bacteremia who are already taking aspirin for secondary prevention of cardiovascular events. We will randomize patients to continue their aspirin or change clopidogrel which is also approved for secondary prevention. Unlike aspirin, clopidogrel may have activity against S. aureus. We wish to determine if changing to clopidogrel will improve outcomes in S. aureus bacteremia in people who otherwise would have a reason to be taking it. This study is an approved sub-study of The Staphylococcus aureus Network Adaptive Platform (SNAP) trial (NCT05137119). If positive, this study will support a Phase 3 RCT in people who do not currently have an indication for clopidogrel.

The participant must meet all inclusion and exclusion criteria for the SNAP Platform (NCT05137119) and also the following inclusion and exclusion criteria: Inclusion Criteria: * Patient is taking aspirin for secondary prevention of cardiovascular disease (coronary, cerebrovascular, or peripheral vascular disease) Exclusion Criteria: * Active bleeding (allowing up to 3 days from platform entry to randomize in the event anti-thrombotic therapy is resumed) * Anticipated major cardiac surgery, neurosurgery, or spine surgery within the next 3 days * Pregnancy * Known receipt of clopidogrel, prasugrel, or ticagrelor within the last month * Allergy to clopidogrel * Concomitant receipt of oral Xa inhibitor