Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Clopidogrel + Aspirin Can Reduce Recurrent Stroke

BMJ; ePub 2018 Dec 18; Hao, Tampi, et al

Dual antiplatelet therapy with clopidogrel and aspirin giving within 24 hours after high risk transient ischemic attack (TIA) or minor ischemic stroke reduces subsequent stroke by about 2%, a recent study found. The systematic review and meta-analysis included pooled data from 3 randomized, placebo controlled trials with >10,000 patients. Among the details:

  • Compared with aspirin alone, dual antiplatelet therapy with clopidogrel and aspirin that was started within 24 hours of symptom onset reduced the risk of nonfatal recurrent stroke, without apparent impact on all-cause mortality.
  • Any increase of serious extracranial bleeding with dual antiplatelet therapy in this setting was minor.
  • Discontinuation of dual antiplatelet therapy within 21 days, and possibility as early as 10 days, of initiation is likely to maximize benefit and minimize harm.


Hao Q, Tampi M, O’Donnell M, Foroutan F, Siemieniuk RAC, Guyatt G. Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack: Systematic reviews and meta-analysis. [Published online ahead of print December 18, 2018]. BMJ. doi:10.1136/bmj.k5108.