A stroke can be a life-changing event that can have permanent effects and the risk of having another stroke is high, especially in the first few months afterwards.
A new study of almost 5,000 adults in 10 countries, published in the New England Journal of Medicine, provided strong evidence that people who had a a TIA, transient ischemic attack, or minor stroke could reduce their risk of heart attack, major stroke or death within three months by 25 percent -- by adding the clopidogrel to aspirin.
“I believe it will greatly increase use of the combination in these patients,” said lead author Dr. Clay Johnston, dean and professor of neurology at Dell Medical School at The University of Texas at Austin.
With a minor stroke that has mild, non-debilitating symptoms or a TIA with a temporary blockage of a brain blood vessel, a patient has up to a 15 percent chance of enduring a more severe stroke within the next three months.
Clopidogrel, also known by its brand name Plavix, is a platelet inhibitor commonly used in patients with a recent heart attack or stroke to prevent future episodes. It’s also used for those with peripheral artery disease.
For this study, treatment began within 12 hours after the first event, since most subsequent stroke events occur soon after the initial TIA or minor stroke.
This trial supports research conducted in Chinese patients and now expands to an international population and diverse health care settings, with the majority of the patients studied living in the United States.
The significant benefit of lowering the risk of recurrent stroke, known as an ischemic event, comes with a relatively small risk of internal bleeding, which is referred to as hemorrhage.
"First, there were three times as many major ischemic events prevented as major hemorrhages produced," Johnston said. "Second, the excess risk of hemorrhage was non-fatal and non-intracranial [not in the brain]."
But these effects were still preferable to another stroke because they were "fully reversible, while strokes are permanent and likely to have lasting effects."
Of course, those who have an increased bleeding risk would have to use extra caution.
The take home message: the combination of aspirin and clopidogrel reduces the risk of recurrent ischemic stroke during the high risk period following a TIA or minor stroke. The possibility of preventing the devastating effects of stroke is a strong recommendation with the cost of a smaller bleeding risk.
"This trial is likely to change practice since most clinicians and patients are usually willing to accept the increased risk of hemorrhage to offset the disabling impact of a stroke," Ralph Sacco, M.D., M.S., professor of neurology at Miller School of Medicine at the University of Miami said in a statement.
Johnston said, "For most patients, this trade-off is very much worthwhile."