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Adding aspirin to clopidogrel after TIA and ischemic stroke

Benefits do not match risks

From the Stroke Unit, Department of Neurology (Dr. Hankey), Royal Perth Hospital and School of Medicine and Pharmacology (Dr. Hankey), University of Western Australia, Perth; and Thrombosis Service (Dr. Eikelboom), McMaster University, Hamilton Health Sciences-General Division, Hamilton, Ontario, Canada.

Address correspondence and reprints requests to Dr. Graeme J. Hankey, Stroke Unit, Department of Neurology, Royal Perth Hospital, 197 Wellington Street, Perth, Australia 6001; e-mail: gjhankey{at}cyllene.uwa.edu.au

Antiplatelet therapy is effective for reducing the risk of recurrent stroke and other serious vascular events in patients with recent TIA and ischemic stroke. Effective antiplatelet agents include aspirin, ticlopidine, clopidogrel, dipyridamole, and the combination of aspirin and dipyridamole. The combination of aspirin and clopidogrel is more effective than aspirin in patients with acute coronary syndrome but is more hazardous than clopidogrel alone in patients with recent TIA and ischemic stroke. Further trials are needed to determine whether the combination of aspirin and clopidogrel may have a role immediately after TIA and ischemic stroke in patients with symptomatic large artery atherothromboembolism and continued for approximately 3 months before switching to less hazardous antiplatelet regimens.

G.J.H. was an investigator in the MATCH trial, and G.J.H and J.W.E have received honoraria from Boehringer-Ingelheim, Sanofi-Synthelabo, and Bristol-Myers Squibb for lecturing at sponsored scientific symposia.

Received August 26, 2004. Accepted in final form December 1, 2004.

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