CANOA: Clopidogrel, aspirin may reduce migraines after ASD closure

ORLANDO, Fla. — Patients who underwent transcatheter atrial septal defect closure and received dual antiplatelet therapy with clopidogrel and aspirin had a lower monthly frequency of migraines over 3 months compared with patients who received aspirin only, according to new data from the CANOA trial.

Josep Rodés-Cabau, MD, and colleagues evaluated the efficacy of clopidogrel plus aspirin vs. aspirin alone for the prevention of migraine attacks post-atrial septal defect (ASD) closure. CANOA was a randomized, double blind trial conducted at 6 hospitals in Canada. The researchers enrolled 171 patients undergoing ASD closure who had no history of migraines (mean age, 49 years; 62% women).

Patients in CANOA were randomly assigned to receive DAPT consisting of aspirin and clopidogrel (n = 84) or single antiplatelet therapy consisting of aspirin alone (n = 87) for 3 months after ASD closure.

The primary efficacy endpoint was monthly number of days with migraines within 3 months after ASD closure. According to results presented at the American Heart Association Scientific Sessions, the mean number of monthly migraine days during the study period was 0.4 in the clopidogrel/aspirin group vs. 1.4 in the aspirin-only group (incident risk ratio = 0.61; 95% CI, 0.41-0.91; P = .04).

Use of clopidogrel and aspirin was also associated with a lower incidence of migraines in the 3 months after closure (9.5% vs. 21.8%; OR = 0.38; 95% CI, 0.15-0.89; P = .031).

Among the patients who did develop migraines after closure, the severity of migraines was less severe in those who received clopidogrel and aspirin (0% vs. 37%; P = .046).

The researchers reported no difference between the treatment groups in the rate of patients with one or more adverse events (clopidogrel/aspirin 16.7% vs. aspirin only 21.8%; P = .44).

The incidence and severity of new-onset migraine was evaluated by the Migraine Disability Assessment questionnaire.

“The present study, which to our knowledge is the first randomized trial in this field, confirmed prior observations on the incidence of migraine attacks following transcatheter ASD closure and demonstrated the usefulness of dual antiplatelet therapy for preventing and reducing, by more than 50%, the burden of such migraine episodes following the procedure,” Rodés-Cabau, from the department of cardiology at Quebec Heart and Lung Institute, Canada, wrote in JAMA. “However, the reduction in monthly migraine days in the entire study population may appear modest due to the high number of patients with no migraine headaches after the procedure.”

The researchers concluded that further research is needed to assess the durability and generalizability of these data. – by Katie Kalvaitis

References:

Rodés-Cabau M, et al. Clinical Science: Special Reports 1. Novel Findings from Next Generation Registries. Presented at: American Heart Association Scientific Sessions; Nov. 7-11, 2015; Orlando, Fla.

Rodés-Cabau M, et al. JAMA. 2015;doi:10.1001/jama.2015.13919.

Disclosures: One researcher reports receiving honoraria for lectures outside the submitted work and an institutional unrestricted grant from St. Jude Medical. The other authors report no relevant financial disclosures.