Dual Antiplatelet Therapy or Aspirin Alone After TIA or Minor Stroke?

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

In patients with minor ischemic stroke or high-risk transient ischemic attack (TIA), treatment with clopidogrel plus aspirin prevents more recurrent strokes, but the combination also causes more bleeding than aspirin alone. The findings were published in the New England Journal of Medicine and presented at the European Stroke Organisation Conference.

Nearly 5000 patients in 10 countries were randomized, within 12 hours of TIA or minor stroke, to clopidogrel plus aspirin or placebo plus aspirin for 90 days. Overall, major ischemic events occurred significantly less often with clopidogrel plus aspirin than with aspirin alone (5.0% vs. 6.5%), with the benefit confined to a reduction in recurrent stroke. However, major hemorrhage occurred more often with clopidogrel (0.9% vs. 0.4%).

An editorialist points out that "most of the benefit regarding stroke prevention occurred in the first week of treatment with the combination, whereas most of the bleeding occurred later." He concludes, "If dual therapy is used, it should be confined to the first 3 weeks after a TIA or minor stroke and then transitioned to monotherapy."