Clopidogrel, aspirin regimen reduces risk of stroke, MI, death by 23%
Patients who suffer minor ischemic stroke or a transient ischemic attack (TIA) can lower the risk for a major stroke within 90 days by taking both clopidogrel and aspirin, according to a study published online May 16 in The New England Journal of Medicine.
Individuals who took clopidogrel and aspirin were 23 percent less likely to experience major stroke, myocardial infarction (MI) or death due to blood clots within three months compared to those who only took aspirin. The combination group, however, did face a higher risk for bleeding.
"The study gives us solid evidence that we can use this drug combination to prevent strokes in the highest-risk people, but not without some risk of bleeding," said lead author Clay Johnston, MD, PhD, with the Dell Medical School at the University of Texas at Austin, in a release.
Both minor stroke and TIA are warning signs that a person has a 3 to 15 percent chance of having a more severe stroke within the next three months, the researchers noted.
The study included 4,881 patients enrolled at 269 international sites in 10 countries. Patients were randomly assigned to receive both clopidogrel and aspirin or aspirin alone.
The researchers assessed whether the cohort were at risk for “major ischemic events,” including ischemic stroke or MI.
Major ischemic events occurred in 5 percent of patients who received clopidogrel in addition to aspirin and 6.5 percent of patients who received aspirin alone. Most of the events occurred in the first week after the initial event.
Bleeding occurred in 23 patients who received the clopidogrel and aspirin combination and in 10 patients who received aspirin alone.
"Of the 33 major hemorrhages that occurred in these 4,881 patients, more than half involved the gastrointestinal tract, and none of them was fatal," said co-author J. Donald Easton, MD, with the University of California, San Francisco School of Medicine. “These largely preventable or treatable bleeding complications of the treatment have to be balanced against the benefit of avoiding disabling strokes.”
The authors suggest more patients who have had a minor ischemic stroke or TIA should receive the combination of clopidogrel and aspirin.
"If you've suffered from a minor stroke or TIA, it's important to see a physician immediately, even in the emergency room, to ensure you're taking steps to avoid a potentially debilitating stroke later on," Johnston said. “There are several tests that need to be done right away to determine the cause of the event and to make sure the best treatments are started as soon as possible."
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.