Stroke and TIA, ischemic, non-embolic : Combined antiplatelet drugs for primary or secondary prevention
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2006 Apr 20;354(16):1706-17. Epub 2006 Mar 12 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, coronary disease, stroke, ischemic, peripheral arterial disease, or multiple risk factors The Use of
combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel (75 mg/d) added to low-dose aspirin
As Treatment, Chronic
Is equal Than
antiplatelet drugs, low-dose aspirin (75 to 160 mg/d) alone
To reduce, at 2 years, cardiovascular events (myocardial infarction, stroke, or cardiovascular death): 6.8% clopidogrel plus aspirin VS 7.3% aspirin alone. Bleeding was not significantly different. Combined treatment worse for non-symptomatic patients
N Engl J Med. 2012 Aug 30;367(9):817-25 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, lacunar, recent The Use of
combined antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/d) added to aspirin (325 mg/d)
As Treatment, Chronic
Is equal Than
aspirin alone
To modify the the risk of recurrent stroke: 2.5% per year dual therapy VS 2.7% per year aspirin alone
Lancet. 2004 Jul 24;364(9431):331-7 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, thrombotic, recidivant, high-risk patients The Use of
combined anti-platelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel, added to aspirin,
As Treatment, Chronic
Is worse Than
only one antipletelet drug, clopidogrel
To reduce new stroke or overall ischemic events (10.5 % per year in intv. VS 11.1 % per year in ctrl.) And increased bleedings, included life-threatening bleedings (1.73 % per year in intv. VS 0.86 % per year in ctrl.)
Stroke. 2012 Apr;43(4):1058-66. Epub 2012 Jan 26 Meta-Analysis
IN stroke, ischemic, thrombotic, transient ischemic attack The Use of
combined antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/d) plus low-dose aspirin
As Prevention, Secondary
Is equal Than
aspirin alone
To reduce stroke recurrence (aspirin+clopidogrel VS aspirin alone : RR 0.67, 95%CI 0.37-1.23). However, a strong trend to reduce combined major cardiovascular events or death (OR 0.68, 95%CI 0.45-1.03, p=0.07).
N Engl J Med. 2013 Jul 4;369(1):11-9 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, transient ischemic attack, or minor cerebral infarction, recents The Use of
combined antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (initial dose of 300 mg, followed by 75 mg/day) plus aspirin (75 mg/day) for 90 days
As Treatment, Acute
Is better Than
aspirine alone
To reduce, at 3 months, stroke (8% clopidogrel+aspirin VS 12% aspirine alone), while having similar rate of major haemorrage (0.3% both)
N Engl J Med. 2018 May 16. doi: 10.1056/NEJMoa1800410. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, transient ischemic attack, or minor cerebral infarction, recents The Use of
combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel (initial dose of 300 mg, followed by 75 mg/day) plus aspirin (50-300 mg/day) for 90 days
As Treatment, Acute
Is better Than
aspirine alone
To reduce, at 3 months, major ichemic events (5% clopidogrel+aspirin VS 6.5% aspirine alone), but increasing the rate of major haemorrage (0.9% combined VS 0.4% aspirin alone)