One drug safer than two after stroke

Following a stroke, treatment with the anti-clotting drug Plavix (clopidogrel) can help prevent future strokes and heart attack. Now, new research shows that Plavix doesn't work any better when given with the blood-thinner aspirin and, in fact, the risk of bleeding complications is increased.

The study, which is reported in The Lancet medical journal, involved 7599 high-risk patients who were treated with Plavix plus either aspirin or and inactive "placebo" for 18 months.

The main outcome of interest was the percentage of patients who experienced another stroke, a heart attack, a death related to these causes, or re-hospitalization for blood flow problems.

Dr. Hans-Jurgen Rupprecht, from Johannes Gutenberg University in Mainz, Germany, and colleagues found that about 16 percent of patients in each group had this outcome, suggesting that two drugs were no more effective than one.

Serious bleeding complications were rare-the rate did not exceed 3 percent in either group. However, the authors found that patients treated with Plavix plus aspirin were 26 to 36 percent more likely to experience such complications than their peers in the Plavix-only group.

The rate of fatal bleeding was comparable and less than 1 percent for both groups.

In a related editorial, Dr. Peter M. Rothwell, from the Radcliffe Infirmary in Oxford, UK, comments that further analysis of the current data "could tell us whether early bruising or (gum) bleeding predict subsequent major bleeding...and whether a short period of treatment with aspirin and Plavix in the acute phase might be effective."

SOURCE: The Lancet, July 24, 2004.