Dual antiplatelet therapy with clopidogrel and aspirin reduces stroke risk

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After a year, patients with a minor stroke or high-risk transient ischemic attack who received dual antiplatelet therapy with clopidogrel and aspirin had significantly fewer subsequent strokes than patients that took only aspirin. The rates of moderate or severe hemorrhage were similar in the groups.

Yilong Wang, MD, PhD, of Capital Medical University in Beijing, and colleagues published their findings online in Circulation on May 8.

The CHANCE (Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events) study was conducted at 114 centers in China between October 2009 and July 2012. Researchers enrolled 5,170 patients who were older than 40 and had acute minor stroke or high-risk transient ischemic attack.

They defined an acute minor stroke as less than or equal to 3 on the National Institutes of Health Stroke Scale and high-risk transient ischemic attack as neurological deficit lasting less than 24 hours due to focal brain ischemia as well as a moderate-to-high risk of stroke recurrence.

Patients in the clopidogrel-aspirin group received 300 mg of clopidogrel and 75 to 300 mg of aspirin on the first day; 75 mg of clopidogrel and 75 mg of aspirin on days 2 through 21; and 75 mg of clopidogrel and placebo aspirin on days 22 through 90. The other group received 75 to 300 mg of aspirin and placebo clopidogrel on the first day and 75 mg of aspirin plus placebo clopidogrel on days 2 through 90.

After 90 days, patients and clinicians had the option to take what they believed was best. At one year, nearly 75 percent of patients were receiving only aspirin.

During the one-year follow-up period, 10.6 percent of patients in the clopidogrel-aspirin group and 14 percent of patients in the aspirin alone group had a stroke. In addition, seven patients in the clopidogrel-aspirin group and nine patients in the aspirin alone group had moderate to severe hemorrhage.

With the study including only Chinese patients, researchers said the results may not be generalizable to other countries. They recommended that the findings should be validated in Western populations.