In a nutshell
This paper studied the effectiveness of the antiplatelet therapy drugs clopidogrel (Plavix) and aspirin on stroke prevention.
Some background
Stroke occurs when there is not enough blood supply to the brain. This can be due to a blood clot blocking a blood vessel. To prevent stroke, antiplatelet drugs are used. These drugs work to prevent platelets (a type of cell in the blood) from sticking together. This then prevents blood from clumping together and obstructing blood flow. Examples of antiplatelet drugs are clopidogrel and aspirin. Aspirin is the main drug used to prevent stroke from occuring. A combination of clopidogrel and aspirin is also sometimes used.
Patients who have already experienced one stroke or a transient ischemic attack (TIA; a brief loss of blood flow to the brain) are at risk of a second stroke. It is not clear whether a combination of clopidogrel and aspirin is more effective at preventing a second stroke in these patients.
Methods & findings
The authors looked at various studies of clopidogrel and aspirin to determine whether a combination of these drugs was more effective than aspirin alone. Five studies with a total of 24,084 patients were analyzed.
Overall, a combination of clopidogrel and aspirin was better at reducing stroke occurrence than aspirin alone. Stroke was 23% less likely to occur when patients took a combination of clopidogrel and aspirin compared to aspirin alone. The combination of drugs led to a 31% decrease of stroke in the short-term (within 90 days of previous stroke or TIA) and a 16% decrease in the long-term (more than 90 days).
There was no significant difference in death rates between patients who took a combination of clopidogrel and aspirin and aspirin alone. There was no significant difference in rates of TIA and bleeding in the brain between patients who took a combination of clopidogrel and aspirin or aspirin alone. However, results found that a combination of clopidogrel and aspirin increased the risk of bleeding by 1.54 times compared with aspirin alone.
The bottom line
The authors concluded that a combination of clopidogrel and aspirin is beneficial but is associated with a higher risk of bleeding.
What’s next?
Talk to your doctor about receiving clopidogrel plus aspirin to prevent stroke.
Published By :
PLOS ONE
Date :
Aug 13, 2015
Interesting overview which would have predicted ASA+Clopidogrel in combination reduces secondary stroke/TIA to a greater degre than ASA alone.
1 We’re doses of Aspirin and Clopidogrel equivalent across all 5 trials?
2 What was Absolute Stroke Risk Reduction expressed as Numbers Needed To Treat? NNT
3 What was Absolute Bleed Risk Increase expressed as Numbers Needed To Harm?
4 Important to note The potential stroke Relative risk reduction does not apply to AF AFib patients where Antiplatelets of no value….Well Controlled Warfarin or Direct Oral AntiCoagulants DOACs reduce stroke risk 70% with NNTs in secondary prevention approx 25.