[Adding aspirin to clopidogrel in secondary prevention of ischemic stroke: no significant benefits. Results of the Match study].
Antiplatelet therapy is the reference treatment for secondary prevention after noncardioembolic ischemic stroke. The main aim of the Match study was to compare the combination of aspirin (75 mg) and clopidogrel (75 mg) with clopidogrel (75 mg) alone in secondary prevention after recent ischemic stroke or transcient ischemic attack in high-risk patients. The incidence of the composite principal endpoint (ischemic stroke, myocardial infarction, vascular death, or acute ischemic event causing hospitalization) was 15.7% at 18 months in patients in the aspirin-clopidogrel arm, compared with 16.7% in the placebo-clopidogrel arm. The relative risk reduction (6.4%) was not significant (95%CI, -4.6 to 16.3; p=0.244). Patients receiving the combination of aspirin and clopidogrel had more life-threatening bleeding than those treated by clopidogrel alone (2.6% vs 1.3%; 95%CI, 1.3 to 2.6; p<0.001). Recruitment that began too late and an over-selected population, with overrepresentation of patients with diabetes and small vessel disease in particular, may partly explain these negative results.
Calvet
David
D
Service de Neurologie, Hôpital Sainte-Anne et Université Paris V René Descartes. d.calvet@ch-sainte-anne.fr
Touzé
Emmanuel
E
Mas
Jean-Louis
JL
D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D002544:Cerebral Infarction / Q000453:epidemiology; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D006760:Hospitalization; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000453:epidemiology; D018579:Patient Selection; D010919:Placebos; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors
D010919:Placebos; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin