Drug Combo May Cut Stroke Risk After TIA
Key points
- Stroke risk declined by a third in people who took a combination of antiplatelet drugs after having a transient ischemic attack (TIA) or minor stroke, a large randomized trial showed.
- The combination of clopidogrel (Plavix) and aspirin led to a 3.5% absolute difference in 90-day stroke rate compared with individuals who took only aspirin (8.2% versus 11.7%).
- Patients treated with the combination had a lower stroke risk with no increased risk of moderate or severe bleeding.
- "The curves for survival free of stroke were particularly steep in the first few days, during which the curves representing the treatment groups diverged dramatically," the authors said.
Stroke risk declined by a third in people who took a combination of antiplatelet drugs after having a transient ischemic attack (TIA) or minor stroke, a large randomized trial showed.
The combination of clopidogrel (Plavix) and aspirin led to a 3.5% absolute difference in 90-day stroke rate compared with individuals who took only aspirin (8.2% versus 11.7%).
Patients treated with the combination had a lower stroke risk with no increased risk of moderate or severe bleeding. The pattern of benefit emphasized the importance of prompt treatment, Yongjun Wang, MD, of Beijing Tiantan Hospital in China, and co-authors reported online in the New England Journal of Medicine.
"The curves for survival free of stroke were particularly steep in the first few days, during which the curves representing the treatment groups diverged dramatically," the authors said.
"Subsequently, the rates of stroke were similar. This suggests that the requirement for randomization within 24 hours after the onset of symptoms, with nearly half the patients enrolled within 12 hours (and treated shortly thereafter), was important."
Although moderate or more severe bleeding did not differ between groups, combination therapy was associated with an overall trend toward more bleeding.
Preliminary results of the trial were first reported in February at the International Stroke Conference in Honolulu.
The trial results are impressive, but several caveats apply to their interpretation, particularly their limited applicability, according to the author of an editorial in the same issue.
"The implication of this trial is that Chinese patients with acute TIA or minor ischemic stroke (onset within the previous 24 hours) who are at high risk for recurrence should be regarded as a medical emergency," wrote Graeme J. Hankey, MD, of the University of Western Australia in Perth.
A transient ischaemic attack (TIA) or 'mini stroke' is caused by a temporary disruption in the blood supply to part of the brain.
The disruption in blood supply results in a lack of oxygen to the brain. This can cause symptoms similar to those of a stroke, such as speech and visual disturbance and numbness or weakness in the arms and legs.
However, a TIA does not last as long a stroke. The effects only last for a few minutes and are usually fully resolved within 24 hours.
F.A.S.T.
The main signs and symptoms of a TIA can be identified by remembering the word F.A.S.T., which stands for Face-Arms-Speech-Time.
Face – the face may have fallen on one side, the person may be unable to smile, or their mouth or eye may have dropped
Arms – the person may not be able to raise both their arms and keep them there due to weakness or numbness in their arms – the person may have slurred speech – if any of these signs or symptoms are present, it is time to dial 999 immediately
Written and revised by
David Cohen, M.D.
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