Science Daily | May 2018 | Stroke prevention drug combo shows promise, study says
According to new research patients who have a minor stroke or TIA, who then take preventative medication may reduce their risk of having a major stroke in the next three months. Experiencing minor stroke and TIA are warning signs that an individual has up to a 15 per cent chance of having a more severe stroke within the next 90 days.
The research from the University of Texas was part of the Platelet-Oriented Inhibition in New TIA and minor ischemic stroke (POINT) trial — a randomized, double-blind, placebo-controlled trial conducted between May 2010 and December 2017. It included patient information from 10 countries throughout North America, Europe and Australia. Patients were included if they had a minor stroke or a transient ischemic stroke and were at high risk of having a major stroke.
The trial has found that taking the clot-preventing drug clopidogrel along with aspirin could lower the risk of experiencing a major stroke in the three months after the TIA (via Science Daily).
The findings have been published in The New England Journal of Medicine
where the full article can be read
Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combination in an international population.
In a randomized trial, we assigned patients with minor ischemic stroke or high-risk TIA to receive either clopidogrel at a loading dose of 600 mg on day 1, followed by 75 mg per day, plus aspirin (at a dose of 50 to 325 mg per day) or the same range of doses of aspirin alone. The dose of aspirin in each group was selected by the site investigator. The primary efficacy outcome in a time-to-event analysis was the risk of a composite of major ischemic events, which was defined as ischemic stroke, myocardial infarction, or death from an ischemic vascular event, at 90 days.
A total of 4881 patients were enrolled at 269 international sites. The trial was halted after 84% of the anticipated number of patients had been enrolled because the data and safety monitoring board had determined that the combination of clopidogrel and aspirin was associated with both a lower risk of major ischemic events and a higher risk of major hemorrhage than aspirin alone at 90 days. Major ischemic events occurred in 121 of 2432 patients (5.0%) receiving clopidogrel plus aspirin and in 160 of 2449 patients (6.5%) receiving aspirin plus placebo, with most events occurring during the first week after the initial event. Major hemorrhage occurred in 23 patients (0.9%) receiving clopidogrel plus aspirin and in 10 patients (0.4%) receiving aspirin plus placebo (hazard ratio, 2.32; 95% CI, 1.10 to 4.87; P=0.02).
In patients with minor ischemic stroke or high-risk TIA, those who received a combination of clopidogrel and aspirin had a lower risk of major ischemic events but a higher risk of major hemorrhage at 90 days than those who received aspirin alone. (Funded by the National Institute of Neurological Disorders and Stroke; POINT ClinicalTrials.gov number, NCT00991029.)
Johnston, S. C., et al. |Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA| New England Journal of Medicine| 2018 | DOI: 10.1056/NEJMoa1800410