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Clopidogrel/Aspirin vs. Aspirin Alone and Migraines After Transcatheter ASD Closure
Quick Takes
- The CANOA trial showed a benefit of clopidogrel in preventing new-onset migraine headaches—in patients with no prior history of migraines—in the 3 months following transcatheter atrial septal defect (ASD) repair.
- For patients included in the CANOA trial, the incidence of new and recurrent migraines at 6 and 12 months post-repair was not known. In addition, the effect on migraine frequency of clopidogrel discontinuation at 3 months post-ASD repair was not known.
- In this study, migraines were uncommon (<4% of subjects) at 6 and 12 months after ASD repair, and there was no evidence that stopping clopidogrel at the 3-month mark resulted in a subsequent increase in migraine incidence.
Study Questions:
What is the 6- and 12-month incidence of both new and recurrent migraines after transcatheter atrial septal defect (ASD) closure?
Methods:
Subjects were ≥18 years, had no prior history of migraines, and had an indication for transcatheter ASD closure. Patients were randomized 1:1 to receive aspirin plus placebo versus aspirin plus clopidogrel for 3 months post-closure. Migraine incidence was assessed by questionnaire at 6 and 12 months. The primary outcome was incidence of migraine attacks at 6 and 12 months post-ASD repair.
Results:
A total of 171 patients were included in the analysis, of whom 87 (50.9%) were in the aspirin/placebo group and 84 (49.1%) were in the aspirin/clopidogrel group. The mean age was 49 years and 62% were women. Whereas 27 (15.8%) CANOA patients had new-onset migraines at 3-month follow-up, at 6-month follow-up, six patients (3.5%) had recurrent migraines and two patients (1.2%) had new-onset migraines. Between 6 and 12 months, four patients (2.3%) had recurrent migraines and no patients had new-onset migraines. There was no difference in the incidence of recurrent migraine or new-onset migraine between the aspirin/placebo group and the aspirin/clopidogrel group at 6- and 12-month follow-up.
Conclusions:
Migraine was rare (<4%) at 6 and 12 months after ASD closure. Unlike with the 3-month CANOA outcomes, no difference in migraine onset or recurrence was seen between the aspirin/placebo group and the aspirin/clopidogrel group at 6 and 12 months.
Perspective:
New-onset migraine headache is observed after ASD closure but is most common in the first 3 months after closure. Patients can be reassured that new and recurrent migraine frequency tends to improve by 6 months post-closure. There is no evidence to support extending the duration of clopidogrel beyond 3 months post-closure for the sole purpose of migraine prevention.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Prevention, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias
Keywords: Aspirin, Heart Defects, Congenital, Heart Septal Defects, Atrial, Migraine Disorders, Platelet Aggregation Inhibitors, Secondary Prevention, Septal Occluder Device
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