Key result
Clopidogrel combined with aspirin did not significantly reduce the risk of secondary TIA or ischemic stroke compared to aspirin alone at 3 months (18.5% vs 37.1%, p=0.129).
Why the study?
Patients with TIA or minor stroke are at risk of strokes, and antiplatelet drugs are used as a precautionary measure to reduce this risk.
Does clopidogrel plus aspirin reduce the risk of secondary stroke or TIA compared to aspirin alone in patients with TIA or minor stroke?
RCT (n=54)
Double-blind
Randomized
No
Does clopidogrel plus aspirin reduce the risk of secondary stroke or TIA compared to aspirin alone in patients with TIA or minor stroke?
Relative Risk: 1.7 (95% CI 0.8–3.6)
Absolute Event Rate: 18.5% vs 37.1%
p-value: p=0.129
Dual antiplatelet therapy with clopidogrel and aspirin showed a non-significant trend toward reducing secondary ischemic stroke or TIA compared to aspirin alone in a small cohort of patients with TIA or minor stroke.
Does not support adding clopidogrel to aspirin after TIA or minor stroke; leaves open benefit in larger powered RCTs.
BACKGROUND: Patients with transient ischemic attack (TIA) or minor stroke are at risk of strokes. One of the precautionary measures to reduce risk of stroke in these patients is administration of antiplatelet drugs. METHODS: The aim of this study was comparison of clopidogrel with aspirin versus aspirin alone in prevention of stroke following TIA or acute minor stroke. This clinical trial study was carried out in Farshchian Hospital, Hamadan, Iran in 2018. Fifty-four patients with TIA, isolated visual attacks, and minor stroke were randomly assigned to receive aspirin 80 mg/day or aspirin 80 mg/day and clopidogrel 75 mg/day for 3 months. RESULTS: After this period, patients were examined for occurrence of myocardial stroke, hemorrhagic/ischemic stroke and drug complications. Ischemic stroke or TIA occurred in 5 (18.5%) patients in clopidogrel-aspirin group and 10 patients (37.1%) in aspirin group (P = 0.12). CONCLUSION: The study suggests a trend toward superiority of administration of clopidogrel with aspirin versus aspirin alone in protection against secondary stroke. Studies in larger cohorts of patients are needed to verify these results.
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Khazaei et al. (2019) conducted an RCT in Transient ischemic attack or minor stroke (n=54). Clopidogrel and aspirin vs. Aspirin 80 mg/day was evaluated on Secondary TIA or ischemic stroke (RR 1.7, 95% CI 0.8-3.6, p=0.129). Clopidogrel combined with aspirin did not significantly reduce the risk of secondary TIA or ischemic stroke compared to aspirin alone at 3 months (18.5% vs 37.1%, p=0.129).
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