Clopidogrel with aspirin is more effective in preventing further strokes than aspirin alone

This study examined whether combining two antiplatelet drugs – clopidogrel (plavix) and aspirin (cartia) – better protects patients with prior minor ischemic stroke or transient ischemic attack (TIA) from further strokes, in comparison to standard treatment with aspirin (cartia) alone.

Ischemic strokes occur when the arteries supplying the brain become narrowed or blocked (by a blood clot), causing severly reduced blood flow (ischemia). TIA ("mini-stroke") refers to a temporary blockage that does not cause any disability. After a stroke, patients are at a high risk for similar events, especially during the first few weeks. For this reason, drugs that prevent clot formation, such as aspirin, are commonly prescribed to stroke patients. Aspirin belongs to the class of antiplatelet drugs, since it inhibits the action of platelets (blood cells that initiate clot formation). Clopidogrel, another antiplatelet drug, works similarly to aspirin, but by a different mechanism. Whether patients can benefit from "dual treatment" (treatment with both drugs) is currently under investigation. However, since both drugs inhibit the formation blood clots, dual treatment may increase the risk of serious bleeding.

In this trial, 5170 patients who suffered a stroke were randomly assigned to receive combination therapy with clopidogrel and aspirin, or a placebo (substance with no therapeutic activity) plus aspirin. Patients were followed for the next 90 days. An additional stroke occurred in 8.2% of patients in the dual therapy group, compared to 11.7% of patients treated with aspirin alone. This correlated to a 32% reduction in the risk for additional strokes. In addition, the patients treated with clopidogrel that did suffer additional strokes, tended towards better outcomes. The risk for serious bleeding did not differ substantially between treatment groups.

This study demonstrated that dual therapy with clopidogrel and aspirin is more effective at preventing further strokes than aspirin treatment alone.

This trial was conducted entirely in China, a country with a very high rate of strokes, but a slightly different distribution of stroke subtypes than in the United States. Similar trials are currently being conducted in the United States and Europe.

Consult with your physician regarding treatment with antiplatelet drugs.