For patients who've recently experienced a transient ischemic attack (TIA) or minor stroke, a daily aspirin regimen can protect against a now more likely second stroke. As an antithrombotic drug—one that reduces the formation of thrombi, or blood clots—aspirin is essential for any home medicine cabinet. And according new to research published in the New England Journal of Medicine, aspirin’s stroke-stopping capabilities really shine through when it's paired with another anti-clotting medication, Clopidogrel, sold as Plavix.
The new research was conducted in a Chinese trial called CHANCE (Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events), as part of a partnership with the University of California, San Francisco (UCSF), which is also taking part in an ongoing, similar trial called POINT (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke).
The success the researchers demonstrated with an aspirin and Plavix regimen could mean a change in the treatment guidelines for all TIAs.
"If POINT confirms CHANCE, then we're done—the two-drug combination becomes the standard of care," said senior study author Dr. S. Claiborne Johnston, a professor of neurology and associate vice chancellor of research at UCSF, in a press release. "Anybody with a transient ischemic attack or minor stroke will get Clopidogrel plus aspirin."
More than 5,000 patients were tested as part of a randomized, double-blind, placebo-controlled trial in China 24 hours after experiencing a minor stroke or high-risk TIA. These patients were chosen for the study because they were already at a high risk of having a major stroke afterward, and so had more to gain from stronger anti-clotting drugs.
A second stroke occurred in 8.2 percent of patients in the clopidogrel and aspirin group, compared to 11.7 percent of those in the aspirin-only group.
Is Two Always Better Than One?
The study makes a strong case for using a two-drug combination to keep recurrent strokes at bay. However, the researchers focused on a two-drug therapy, as opposed to one drug over another. Because the trial tested clopidogrel and aspirin versus aspirin alone, the question was really whether Plavix was of any additional help, Johnston explained.
Also, the researchers focused on a brief period of time right after a TIA or minor stroke, in which anti-clotting drugs are the most effective. “This is really about the first three months immediately after an event; the results don’t apply later during which we know the combination has no net benefit,” Johnston said.
Johnston said that while the results are very promising, he's awaiting confirmation from the U.S. POINT trial.
“This seems to be a large effect and a safe regimen, but Chinese healthcare is different and some genetic differences could also be important,” he added.