Adding aspirin to clopidogrel after TIA and ischemic stroke: benefits do not match risks.
Antiplatelet therapy is effective for reducing the risk of recurrent stroke and other serious vascular events in patients with recent TIA and ischemic stroke. Effective antiplatelet agents include aspirin, ticlopidine, clopidogrel, dipyridamole, and the combination of aspirin and dipyridamole. The combination of aspirin and clopidogrel is more effective than aspirin in patients with acute coronary syndrome but is more hazardous than clopidogrel alone in patients with recent TIA and ischemic stroke. Further trials are needed to determine whether the combination of aspirin and clopidogrel may have a role immediately after TIA and ischemic stroke in patients with symptomatic large artery atherothromboembolism and continued for approximately 3 months before switching to less hazardous antiplatelet regimens.
Hankey
Graeme J
GJ
Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia. gjhankey@cyllene.uwa.edu.au
Eikelboom
John W
JW
D001241:Aspirin / Q000009:adverse effects*; D002545:Brain Ischemia / Q000188:drug therapy / Q000517:prevention & control*; D000077144:Clopidogrel; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D018570:Risk Assessment; D055502:Secondary Prevention; D020521:Stroke / Q000188:drug therapy / Q000517:prevention & control*; D013923:Thromboembolism / Q000150:complications / Q000188:drug therapy; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin