Two-drug combination could reduce stroke risk
Washington: A simple drug regimen of two anti-clotting drugs - clopidogrel and aspirin - can lower the risk of suffering a stroke by about one-third, a new clinical trial has showed.
The clinical trial involved 5,170 people, who were hospitalized after suffering minor ischemic strokes or stroke-like events known as transient ischemic attacks, or TIAs, in which blood flow to the brain is briefly blocked, and was conducted at multiple sites in China and designed in partnership with a physician at UC San Francisco.
Then all patients were randomized into two groups and treated for three months with aspirin alone or aspirin plus clopidogrel, which is marketed as Plavix. The three-month period following stroke is considered the most critical for medical intervention.
Overall, 8.2 percent of patients taking both drugs suffered subsequent strokes in the three months of follow-up compared to 11.7 percent of patients taking aspirin alone.
The Chinese trial, called CHANCE ( Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events), is nearly identical to a National Institutes of Health-sponsored trial that is already enrolling patients in the United States, including at UCSF, called POINT (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke).
S. Claiborne Johnston, MD, PhD, a professor of neurology and associate vice chancellor of research at UCSF who was a senior author on the study, said that if POINT confirms CHANCE, then the two-drug combination could become the standard of care.
He said that anybody with a transient ischemic attack or minor stroke will get clopidogrel plus aspirin.
The POINT trial is important, said Johnston, because genetics, risk factors, and medical practice differences could all lead to differences in trial results in China compared to other countries. Johnston is the principal investigator of the POINT trial.
The study has been published in the New England Journal of Medicine.