Skip to Main Content
Dual Antiplatel..

+

Current guidelines for the secondary prevention of noncardioembolic ischemic stroke recommend antiplatelet monotherapy to reduce the risk of fatal thrombi. Aspirin, aspirin combined with dipyridamole, and clopidogrel are antiplatelet agents that have demonstrated effectiveness in reducing rates of recurrent vascular events.1 Currently, dual antiplatelet therapy is considered beneficial among patients experiencing acute coronary syndromes, patients receiving stents, and patients with atrial fibrillation to reduce the risk of cardioembolic stroke when anticoagulation treatment is not appropriate.2,3 These beneficial results have not been seen in all patients, though. Some trials evaluating dual antiplatelet therapy have found no benefit in the prevention of an ischemic stroke and an increased risk of bleeding.1,4,5 Despite these studies, further research into dual antiplatelet therapy is warranted. Due to the limited representation of certain sub-groups of stroke patients (such as lacunar stroke) in these studies, further clarification of the role of dual antiplatelet therapy for stroke prevention is needed. Lacunar strokes are one sub-set of stroke defined by blockage in any of the small penetrating arteries of the brain. While a portion of lacunar strokes may be caused by emboli, most are commonly the result of diseased vessels and subsequently managed with antiplatelet monotherapy as the standard of care.6               

+

The Secondary Prevention of Small Subcortical strokes (SPS3) investigators sought to determine the role of clopidogrel and aspirin in the prevention of recurrent stroke.6 A randomized, double blind trial of 3020 patients took place to evaluate the stroke recurrence rates in patients with recent lacunar infarcts. Patients were eligible for the study if they were age ≥ 30 years, had symptomatic lacunar stroke within the last 180 days, and did not have major risk factors for cardioembolic stroke. Exclusions to the trial included MRI evidence of recent or remote cortical infarct, large subcortical infarct, cortical ischemic stroke, history of cerebral or intracranial hemorrhage, and disabling stroke with a Rankin score of 4 or more. The study incorporated two treatment arms with patients randomized to receive either 75 mg clopidogrel and 325 mg aspirin daily or placebo and 325 mg aspirin daily. Participants were followed for an average of 3.4 years with a primary endpoint of stroke recurrence between the two treatment groups.6

+

Participants were a mean of 63 years of age with 63% being male. The trial was stopped within 10 months of the planned end date due to a lack of efficacy and evidence of harm. Results showed that recurrent stroke occurred in 2.7% of patients receiving aspirin and placebo compared to 2.5% of patients receiving aspirin and clopidogrel (HR 0.92, p=0.48). Dual antiplatelet therapy was found to correlate with an 18% reduction in the risk of recurrent ischemic stroke, but the decrease was not found to be statistically significant (HR 0.82, p=0.13). Of those with recurrent stroke, 71% had a lacunar stroke and dual antiplatelet therapy showed no benefit in reducing the risk. The aspirin and clopidogrel combination also demonstrated an increase in all-cause mortality ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.