Long-term clopidogrel therapy after stroke safer than dual-antiplatelet therapy

Using clopidogrel monotherapy over a long period of time may be a safer option than long-term dual-antiplatelet therapy for stroke prevention in patients with ischemic stroke or transient ischemic attack (TIA). A study published in the Oct. 1 issue of Annals of Internal Medicine found that dual-antiplatelet therapy did not reduce overall risk of stroke compared with clopidogrel alone or aspirin alone, but was associated with a higher risk of intracranial hemorrhage (ICH).

In a meta-analysis, researchers led by Meng Lee, MD, of Chang Gung Memorial Hospital in Chiayi, Taiwan, reviewed data from seven previous randomized, controlled clinical trials that involved patients with an ischemic stroke or TIA history and compared dual- and single-antiplatelet therapy in patients treated for at least one year. The trials used either aspirin monotherapy or clopidogrel (Plavix, Bristol-Myers Squibb) monotherapy.

The studies in the analysis included 39,574 participants who were randomly assigned to either single-antiplatelet therapy or dual-antiplatelet therapy. As endpoints, the authors assessed recurrent stroke and ICH.

There was no difference between the aspirin monotherapy group and the dual-antiplatelet therapy group (relative risk [RR] 0.89). There was also no difference between the clopidogrel group and the dual-therapy group (RR 1.01).

They found a lower risk for gastrointestinal bleeding among the clopidogrel group compared with the aspirin group.

When comparing risk for ICH, there was no difference between the aspirin group and the dual-therapy group (RR 0.99), but the dual-therapy risk was higher when compared with clopidogrel (RR 1.46).

“Therefore, the overall clinical risk-benefit profile of long-term dual-antiplatelet therapy compared with clopidogrel monotherapy is not necessarily favorable for future vascular risk reduction in this patient population,” the authors wrote.

However, while long-term dual-antiplatelet therapy may not be the best option, short-term use during the acute stage of an ischemic stroke or TIA may be beneficial, although the ideal treatment duration is still unknown.