Combo therapy lowers blood clot risk after stroke

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Treatment with aspirin plus clopidogrel (sold in the US under the tradename Plavix) is more effective than aspirin alone in reducing tiny blood clots (microembolisms) in Stroke patients, according to the results of a multicenter European study. Combination therapy may therefore be an effective treatment for preventing a second Stroke in these patients.

“When patients come in with a heart attack, we treat them quite aggressively with multiple therapies,” lead investigator Dr. Hugh S. Markus told Reuters Health.

Markus, of St. George’s Hospital Medical School, London and colleagues, conducted a study with patients with blocked carotid arteries (which carry blood to the brain) and Transient ischemic attack (TIA) ("mini-strokes") or who had a stroke in the previous three months.

The patients were included in the study if they had evidence of microembolisms, which indicates a high risk for a second stroke, Markus explained. The 91 subjects were randomly assigned to clopidogrel plus aspirin or to aspirin alone.

On day seven, the results of ultrasound tests indicated that 46 percent of combination therapy patients still had evidence of microembolisms, versus 73 percent of patients on aspirin only. These findings were confirmed by laboratory studies that looked at the activity of platelets, blood cells involved in the formation of blood clots.

There were no strokes and four recurrent mini-strokes in the clopidogrel group versus four strokes and seven mini strokes in the aspirin-only group.

“These results,” Markus concluded, “show if we treat stroke patients with more aggressive therapy we can significantly reduce the number of (microembolisms),” which should translate into reduced stroke risk.

SOURCE: Circulation, May 3, 2005.

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