Combination Therapy May Prevent Stroke
Results from an international clinical trial of more than 4,880 participants show that combining clopidogrel and aspirin following a small stroke or experiencing minor stroke symptoms decreases the risk of a new stroke, heart attack, or other ischemic event within 90 days. The combination therapy was also associated with an increase in major bleeding, although many of those episodes were nonfatal and did not occur in the brain. The results were published in the New England Journal of Medicine. The study was supported by the National Institute of Neurological Disorders and Stroke (NINDS), a part of NIH.
“These findings are likely to have a global effect on clinical practice, as these drugs are easily available in many hospitals and clinics,” said Walter Koroshetz, MD, Director of NINDS. “As the benefit of the combination was concentrated in the first two weeks, while risk of bleeding was constant over 90 days, it may be especially valuable in acute management of a minor ischemic stroke or transient ischemic attack (TIA).”
The Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) clinical trial follows an earlier study that showed benefits of this drug combination in a Chinese population. POINT was conducted to see whether the benefits could be expanded to a more diverse group of patients.
The study, led by S. Claiborne Johnston, MD, PhD, Dean and Professor of Neurology at Dell Medical School at the University of Texas at Austin, included patients who had had either a minor stroke or a TIA, in which blood supply to a part of the brain is briefly stopped and can be a risk factor for a larger stroke. Study participants were given clopidogrel and aspirin or aspirin alone to see whether the combination therapy could prevent a larger stroke within three months.
Dr. Johnston’s team found that the combination of clopidogrel and aspirin prevented more ischemic events, such as stroke and heart attack, compared with aspirin alone. The results showed that 5% of patients in the combination therapy group and 6.5% of patients taking only aspirin had such an event within 90 days. The combination therapy was associated with a greater risk of major bleeding or hemorrhage than aspirin alone, however. In the aspirin-only group, 0.4% of patients suffered a major hemorrhage, but 0.9% of patients taking clopidogrel and aspirin had severe bleeding.