title: The efficacy and adverse reaction of bleeding of clopidogrel plus aspirin as compared to aspirin alone after stroke or TIA: a systematic review.
abstract: OBJECTIVE
  Given the high risk of stroke after TIA (transient ischemia attack) or stroke and the adverse reaction of bleeding of antiplatelets, we undertook a meta-analysis, reviewed randomized controlled trials (RCTs) comparing aspirin plus clopidogrel with aspirin alone to determine the efficacy and adverse reaction of bleeding of the two protocols in the prevention of stroke.
  
  
  METHODS
  We analyzed the incidences of stroke, bleeding and severe bleeding by using fixed-effect model or random-effect model on the basis of the result of heterogeneity test.
  
  
  RESULTS
  Five qualified RCTs satisfied the inclusion criteria. We found that treatment with aspirin plus clopidogrel was associated with lower incidence of stroke (Risk Ratio (RR), 0.66, 95% confidence interval (CI), 0.47 to 0.93), higher incidence of bleeding (RR, 1.75, 95% CI, 1.48 to 2.05) as compared with aspirin-alone treatment. In terms of severe bleeding, no statistical difference existed between them (RR, 2.21, 95% CI, 0.25 to 19.52).
  
  
  CONCLUSIONS
  The combined use of aspirin and clopidogrel is more effective than aspirin alone for patients with previous TIA or stroke for the prevention of stroke, with risk of bleeding being higher. No statistical difference was found in severe bleeding between the two treatment protocols.
authors.affiliation: Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Huang
authors.forename: Man
authors.initials: M
authors.lastname: Li
authors.forename: Jian-Yong
authors.initials: JY
authors.lastname: Li
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.forename: Yuan-Peng
authors.initials: YP
authors.lastname: Xia
authors.forename: Ling
authors.initials: L
authors.lastname: Mao
authors.forename: Bo
authors.initials: B
authors.lastname: Hu
mesh_terms: D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D001760:Bleeding Time; D000077144:Clopidogrel; D006470:Hemorrhage / Q000503:physiopathology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy* / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin