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DAPT reduced stroke rate in patients with minor stroke, TIA
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Compared with aspirin alone, the combination of clopidogrel and aspirin in patients with transient ischemic attack or minor stroke within 24 hours of symptom onset was superior at reducing the risk for stroke at 90 days.
The study results, which were published today in The New England Journal of Medicine, involved 5,170 patients from 114 centers in China. Patients were randomly assigned within 24 hours of onset of minor ischemic stroke or high-risk TIA to either clopidogrel (Plavix, Sanofi-Aventis) plus aspirin or to placebo plus aspirin. Dual antiplatelet therapy consisted of an initial dose of 300 mg clopidogrel followed by 75 mg per day for 90 days and aspirin at a dose of 75 mg per day for the first 21 days. The aspirin group received placebo plus 75 mg aspirin per day for 90 days.
At 90-day follow-up, the intention-to-treat analysis revealed that stroke, the study’s primary outcome, occurred in 8.2% of patients in the DAPT group vs. 11.7% of those in the aspirin group (HR=0.68; 95% CI, 0.57-0.81). This reduction of stroke did not come at the cost of an increased risk for moderate or severe hemorrhage in the DAPT group (both 0.3%; P=.73). Similarly, the rate of hemorrhagic stroke did not differ between groups (both 0.3%; P=.98).
In an accompanying editorial, Graeme J. Hankey, MD, of the department of neurology, Royal Perth Hospital, Australia, wrote that the results observed in this trial cannot be generalized to most patients and may not apply to non-Chinese patients.
“Clinicians should continue to enroll non-Chinese patients with acute TIA and minor ischemic stroke into ongoing large clinical trials of the safety and efficacy of dual and triple antiplatelet therapy,” he wrote. “Moreover, I hope that researchers will evaluate new antiplatelet agents (eg, ticagrelor [Brilinta, AstraZeneca] and prasugrel [Effient, Daiichi-Sankyo/Eli Lilly] and new anticoagulant agents (eg, rivaroxaban [Xarelto, Janssen Pharmaceuticals]) that are effective in atherothrombotic ACS in patients with acute TIA and minor ischemic stroke due to arterial thromboembolism.”
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