Combining clopidogrel and aspirin following a small stroke or minor stroke symptoms reduces the risk of a new stroke, heart attack, or other ischemic event within 90 days, say researchers from the National Institute of Neurological Disorders and Stroke.
In POINT (Platelet-Oriented Inhibition in New TIA and minor ischemic stroke), an international clinical trial, 5% of the combination therapy group and 6.5% of the aspirin-only group had an ischemic event within 90 days. The benefit of the combination was concentrated in the first 2 weeks, while the risk of bleeding was constant over 90 days, says Walter Koroshetz, MD, director of NINDS, thus the treatment may be most valuable in acute management of a minor ischemic stroke or TIA.
The study was stopped early not only because the combination therapy was more effective than aspirin alone in preventing severe strokes, but also due to the risk of severe hemorrhage. The combination therapy was associated with an increase in major bleeding, although many of the episodes were not fatal and occurred outside the brain: 0.9% of the combination group had a major hemorrhage, compared with 0.4% of the aspirin-only group.
“Overall, the risk of severe bleeding was very small,” says lead investigator S. Claiborne Johnston, MD, PhD, “but it was not zero.”