Update on clopidogrel and dual anti-platelet therapy: neurology

Patients suffering a transient ischaemic attack (TIA) or ischaemic stroke (IS) have a high recurrence risk. The inhibition of platelet function is effective in the reduction of secondary vascular events in patients with TIA or stroke. This is true for acetylsalicylic acid (ASA), clopidogrel, ticlopidine, and the combination of ASA and slow-release dipyridamole. This review analyses the results of recent trials like clopidogrel as well as the combination of clopidogrel plus ASA. Clopidogrel is superior to ASA in the prevention of vascular events in patients with IS, myocardial infarction, or peripheral arterial disease. The difference is highest for high-risk patients such as diabetics, patients who underwent coronary bypass surgery, and patients with additional vascular events. A prediction model which allows to identify patients in whom clopidogrel is superior to ASA for the secondary prevention of stroke is presented. In high-risk patients with TIA or stroke, the combination of clopidogrel plus ASA is not superior to clopidogrel monotherapy, but results in a higher rate of bleeding complications. Combination therapy is superior to aspirin monotherapy for the prevention of strokes but not for a combined vascular endpoint.