Clopidogrel Plus Aspirin Tops Aspirin Alone in Reducing Stroke in High-Risk Patients
In patients with recent transient ischemic attack (TIA) or acute minor stroke, dual antiplatelet therapy with clopidogrel plus aspirin reduced the risk of stroke by 32 percent compared to therapy with aspirin alone, according to results from the CHANCE trial, published June 26 in the New England Journal of Medicine.
The authors conclude that "among patients with TIA or minor stroke who can be treated within 24 hours after the onset of symptoms, the combination of clopidogrel and aspirin is superior to aspirin alone for reducing risk of stroke within the first 90 days and does not increase risk of hemorrhage."
In an accompanying editorial, Graeme Hankey, MBBS, MD, University of Western Australia, praised the rigor of the trial, but cautioned that results couldn't be generalized to most patient populations because investigators selected a very specific, high-risk cohort for their study. He also noted that the results might not apply to non-Chinese populations with different forms of underlying arterial disease and different prevalences of genetic polymorphisms in cytochrome P-450 isozymes, which metabolize clopidogrel to its active forms.
"The implication of this trial is that Chinese patients with acute TIA or minor ischemic stroke who are at high risk for recurrence should be regarded as a medical emergency," Dr. Hankey said. "They should be treated immediately with clopidogrel plus aspirin."
Dr. Hankey advised clinicians with non-Chinese patients with acute TIA or minor ischemic stroke to enroll them into to the similar POINT and TARDIS trials. He also called on researchers to evaluate newer antiplatelet agents in patients with acute TIA and minor ischemic stroke due to arterial thromboembolism.
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