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Treating Patients Who Have Recurrent Strokes While Taking Aspirin

Summary and Comment |
February 25, 2014

Treating Patients Who Have Recurrent Strokes While Taking Aspirin

  1. Allan S. Brett, MD

Long-term aspirin plus clopidogrel wasn't better than aspirin alone.

  1. Allan S. Brett, MD

In the previously published SPS3 trial, 3000 patients who experienced lacunar strokes during the previous 6 months were randomized to receive aspirin alone or aspirin plus clopidogrel. During several years of follow-up, dual antiplatelet therapy did not prevent recurrent stroke and increased risk for major hemorrhage and death (NEJM JW Neurol Aug 29 2012). Now, in a post hoc analysis from this study, researchers present data on the 838 patients who already had been taking prophylactic aspirin at the time of the lacunar stroke that qualified them for the trial.

Outcomes in this subgroup mirrored those of the larger study. During mean follow-up of 3.5 years, the annual stroke rate was 3% in both the aspirin monotherapy and dual antiplatelet therapy treatment groups. However, annual mortality was higher with dual therapy than with aspirin alone (2.9% vs. 1.4%; P=0.004), and gastrointestinal bleeding was more common with dual therapy.

Comment

In this analysis, aspirin plus clopidogrel was not more effective than aspirin alone for preventing subsequent strokes in patients with previous lacunar strokes that occurred during aspirin therapy. Note that SPS3 patients were randomized an average of 2.5 months after their index lacunar strokes. In contrast, in the recently published CHANCE trial (NEJM JW Neurol Jun 26 2013), short-term dual therapy was more effective than aspirin alone in patients with transient ischemic attack or minor stroke who were randomized within 24 hours; in that study, no distinction was made between lacunar strokes and other stroke subtypes.

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (1)

Dr. V Kantariya MD Physician, Family Medicine/General Practice

Combination long-term Antiplatelet Therapy for Secondary Stroke Prevention is non-welcome. As related to short-term dual antiplatelet therapy for transient ischemic attack or minor stroke: it Works.Make the Right Choice: Minor Stroke=Big Trouble, long-term dual therapy may be Double Trouble.

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