Dual antiplatelet therapy, which combines aspirin and clopidogrel, reduces the risk of relapse of cardiovascular events in people who have had a minor stroke or TIA, a transient ischemic attack.
Having a minor stroke or TIA exposes patients to a high risk of relapse of cardiovascular events, which can lead to devastating stroke. Currently, these patients benefit from antiplatelet therapy with just aspirin. However, several clinical trials have shown that coupling aspirin with clopidogrel, a platelet antiaggregant, may reduce the risk of relapse.
Decreased risk of relapse
In order to examine whether or not dual treatment actually reduces the risk of having a new cardiovascular event for people who have had a first minor stroke or a TIA, the researchers analyzed the results of three previous studies involving a total of 10,447 patients. Their results were published in the journal BMJ.
The results show that dual antiplatelet therapy, initiated within 24 hours of the first mini stroke or TIA, reduces the risk of relapse of a new stroke by approximately 2%. In addition, analysis of the findings from these three studies shows that relapses occur primarily in the days following the first stroke. However, it is exactly during this period that the double treatment is the most effective compared to taking single aspirin. The study also reveals that beneficiaries of dual antiplatelet therapy benefit from a better quality of life.
Relative side effects
Nevertheless, the study shows that dual antiplatelet therapy is likely to slightly increase the risk of moderate or major extra-cranial bleeding. However, with a risk of 0.2%, these events are much less common than minor stroke relapse or AIT.
Minor bleeding also increases with dual treatment, but the effect is quite small since the risk is increased by 0.7%, which is much less important than the risk of recurrence of a new stroke.
"The dual antiplatelet therapy with clopidogrel and aspirin given within 24 hours of TIA or stroke reduces the risk of subsequent stroke by about 2%, with few serious adverse consequences," say the researchers. .
If the reduction in stroke rates is observed from the first day of treatment in patients who took aspirin and clopidogrel, it decreases after 10 days of treatment. After 21 days of treatment, the beneficial effects of reducing the risk of relapse are balanced between monotherapy or dual antiplatelet therapy, the risk of relapse becoming almost similar. "Stopping double antiplatelet therapy by the 10th day, and at the latest 21 days after the start of treatment, is likely to maximize its net benefits," the researchers conclude.