This article is more than 5 years old. Information may no longer be current.
Adding aspirin to clopidogrel failed to prevent recurrent strokes
Click Here to Manage Email Alerts
Combining clopidogrel with aspirin did not appear to reduce the risk for recurrent stroke in patients with recurrent lacunar stroke, although the combination was associated with a significant increase in the risk for bleeding and death.
Researchers for the Secondary Prevention of Small Subcortical Strokes (SPS3) trial randomly assigned 3,020 patients (mean age, 63 years; 63% men) with recurrent symptomatic lunar infarcts to receive clopidogrel 75 mg (Plavix, Sanofi-Aventis) or placebo in addition to aspirin 325 mg daily. Mean follow-up was 3.4 years.
One hundred twenty-five strokes occurred at a rate of 2.5% per year in the aspirin with clopidogrel group vs. 138 strokes at 2.7% per year in the aspirin alone group These data suggested that adding aspirin to clopidogrel did not significantly decrease the risk for recurrent stroke (HR=0.92; 95% CI, 0.72-1.16), recurrent ischemic stroke (HR=0.82; 95% CI, 0.63-1.09), or disabling or fatal stroke (HR=1.06; 95% CI, 0.69=1.64), according to the researchers. Seventy-one percent of classifiable recurrent ischemic strokes (133 of 187) were lacunar strokes.
Risk for major hemorrhage, however, doubled with the use of clopidogrel and aspirin (105 hemorrhages, 2.1% per year) vs. aspirin alone (56 hemorrhages, 1.1% per year), with an HR of 1.97 (95% CI, 1.41-2.71).
With 113 deaths in the clopidogrel and aspirin group and 77 deaths in the aspirin alone group, all-cause mortality also appeared to be higher in the dual antiplatelet therapy group (HR=1.52; 95% CI, 1.14-2.04).
Results from the SPS3 trial were previously reported at the International Stroke Conference 2012.
Disclosure: This study was supported by a grant from the National Institute of Neurological Disorders and Stroke and by Sanofi-Aventis and Bristol-Myers Squibb, which donated the clopidogrel and matching placebo used in the study. See the study for a full list of researchers’ disclosures.
Click Here to Manage Email Alerts