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Cardiovascular disease

Clopidogrel plus aspirin reduces stroke risk in patients with ischaemic events

The incidence of major ischaemic events is reduced in at-risk patients if clopidogrel is given alongside aspirin, study finds.

Receiving clopidogrel in addition to aspirin reduces the risk of major ischaemic events in people with minor ischaemic stroke or high-risk transient ischaemic attack (TIA), according to a study published in the New England Journal of Medicine (16 May 2018)[1].

Researchers randomly assigned patients presenting within 12 hours of minor ischaemic stroke or high-risk TIA to clopidogrel (600mg loading dose and 75mg/day thereafter) and aspirin (50–325mg/day), or placebo and aspirin, for 90 days.

The team found risk of major ischaemic events among those who received clopidogrel was lower than in those who received aspirin alone (5.0% vs 6.5%; hazard ratio [HR] 0.75, 95% confidence interval [CI] 0.59–0.95; P=0.02). There was also an elevation in the risk of major haemorrhage at 0.9% compared with 0.4%, respectively (HR 2.32, 95% CI 1.10–4.87; P=0.02).

“The study gives us solid evidence that we can use this drug combination to prevent strokes in the highest-risk people, but not without some risk of bleeding,” concluded lead author Clay Johnston from the University of Texas, Austin.

Clopidogrel is not currently licensed for this indication but is recommended by the National Institute for Health and Care Excellence.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2018.20205083

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