title: Combination aspirin and clopidogrel for secondary prevention of ischemic stroke.
abstract: Though antiplatelet agents are the mainstay of antithrombotic therapy for secondary prevention of noncardioembolic cerebral ischemic events, the efficacy of combination aspirin and clopidogrel has yet to be clarified by clinical trials. Current evidence suggests that there is no role for long-term combination of aspirin/clopidogrel for secondary stroke prevention. Recent preliminary data from the CHANCE (Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events) trial suggests that stroke recurrence at 90 days is reduced by a short course (21 days) of combination aspirin/clopidogrel initiated within 24 hours of minor stroke or TIA (Transient Ischemic Attack) compared with aspirin alone [1••] (Table 1). Other ongoing trials, which are also investigating the role of short-term combination antiplatelet therapy initiated immediately after minor stroke and TIA, will determine if these findings will be replicated.
authors.affiliation: Division of Neurology, (Department of Medicine), Vancouver Stroke Program, Brain Research Center, University of British Columbia, S169-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, thalia.field@ubc.ca.
authors.forename: Thalia S
authors.initials: TS
authors.lastname: Field
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakajima
authors.forename: Oscar R
authors.initials: OR
authors.lastname: Benavente
references.citation: Neurology. 2011 Dec 13;77(24):2104
references.pmid: 22170942
references.citation: J Neurol Sci. 1996 Nov;143(1-2):1-13
references.pmid: 8981292
references.citation: Stroke. 2011 Dec;42(12):3651-4
references.pmid: 22052510
references.citation: Lancet. 2010 Jul 10;376(9735):112-23
references.pmid: 20561675
references.citation: Stroke. 2009 May;40(5):e322-30
references.pmid: 19228835
references.citation: JAMA. 1987 Apr 17;257(15):2043-6
references.pmid: 3550162
references.citation: Lancet Neurol. 2007 Feb;6(2):94-7
references.pmid: 17239789
references.citation: Neurology. 2006 Apr 25;66(8):1187-91
references.pmid: 16636236
references.citation: Lancet. 2009 May 30;373(9678):1849-60
references.pmid: 19482214
references.citation: Lancet. 2004 Jul 24-30;364(9431):331-7
references.pmid: 15276392
references.citation: N Engl J Med. 2008 Sep 18;359(12):1238-51
references.pmid: 18753638
references.citation: Lancet Neurol. 2007 Feb;6(2):182-7
references.pmid: 17239805
references.citation: Circulation. 2010 Jun 15;121(23):2575-83
references.pmid: 20516378
references.citation: Int J Stroke. 2006 May;1(2):74-80
references.pmid: 18706048
references.citation: JAMA. 2011 Nov 9;306(18):1983-92
references.pmid: 22068990
references.citation: N Engl J Med. 2006 Apr 20;354(16):1706-17
references.pmid: 16531616
references.citation: Acta Neurol Scand. 1987 Dec;76(6):413-21
references.pmid: 3324618
references.citation: Stroke. 2012 Apr;43(4):1058-66
references.pmid: 22282894
references.citation: Neurology. 2004 Feb 24;62(4):569-73
references.pmid: 14981172
references.citation: Neurology. 2009 Jun 2;72(22):1941-7
references.pmid: 19487652
references.citation: J Med Assoc Thai. 2005 Nov;88 Suppl 3:S148-54
references.pmid: 16858953
references.citation: Lancet. 2007 Oct 20;370(9596):1432-42
references.pmid: 17928046
references.citation: Lancet. 2008 May 10;371(9624):1612-23
references.pmid: 18468545
references.citation: N Engl J Med. 2011 Sep 15;365(11):993-1003
references.pmid: 21899409
references.citation: Lancet. 2006 Jun 10;367(9526):1903-12
references.pmid: 16765759
references.citation: Stroke. 2012 Aug;43(8):2157-62
references.pmid: 22826359
references.citation: N Engl J Med. 2005 Mar 31;352(13):1305-16
references.pmid: 15800226
references.citation: Eur Heart J. 2007 Sep;28(18):2200-7
references.pmid: 17673448
references.citation: Am J Cardiol. 2009 May 15;103(10):1359-63
references.pmid: 19427428
references.citation: Lancet Neurol. 2010 May;9(5):489-97
references.pmid: 20335070
references.citation: Am Heart J. 2010 Sep;160(3):380-386.e1
references.pmid: 20826243
references.citation: Neurotherapeutics. 2011 Jul;8(3):475-87
references.pmid: 21761240
references.citation: Circulation. 2005 May 3;111(17):2233-40
references.pmid: 15851601
references.citation: Lancet Neurol. 2007 Nov;6(11):961-9
references.pmid: 17931979
references.citation: Stroke. 2011 Jan;42(1):227-76
references.pmid: 20966421
references.citation: Lancet. 2006 May 20;367(9523):1665-73
references.pmid: 16714187
references.citation: N Engl J Med. 2012 Aug 30;367(9):817-25
references.pmid: 22931315
references.citation: N Engl J Med. 2009 May 14;360(20):2066-78
references.pmid: 19336502
references.citation: Lancet Neurol. 2004 Jul;3(7):408-14
references.pmid: 15207797
references.citation: Lancet Neurol. 2010 Feb;9(2):159-66
references.pmid: 20060783