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Secondary Stroke Prevention: Are 2 Meds Better Than 1? Print E-mail
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จันทร์, 18 มีนาคม 2013

Hans-Christoph Diener, MD, PhD
Mar 07, 2013
Ladies and gentlemen, good morning. I am Christoph Diener, a neurologist from the Department of Neurology at the University of Essen. My topic today is early secondary stroke prevention. Patients who have had a transient ischemic attack (TIA) or stroke are at high risk for recurrent stroke within the first 7 days. This condition is usually treated with aspirin. However, there are indications that in cardiology, combination therapy with 2 antiplatelet drugs might be more effective. The MATCH trial has shown in the past that long-term treatment with 2 antiplatelet drugs (eg, aspirin and clopidogrel) is not superior to clopidogrel monotherapy, and it carries a higher risk for bleeding.
At the International Stroke Conference in Hawaii a few days ago, the CHANCE trial[1] was reported from China. This trial recruited 5170 patients who had had either a high-risk TIA or a minor stroke and randomly assigned them to 2 groups. One group received aspirin monotherapy (75 mg for 3 months), and the other group received a loading dose of clopidogrel followed by 21 days of 75-mg clopidogrel in combination with aspirin, which was followed by clopidogrel monotherapy. At 90 days, there was a statistically significant superiority of combination therapy over monotherapy. This was true for survival free from stroke. For the combined endpoints of stroke, myocardial infarction, and vascular death, the relative risk reduction was about 30%. There was also a 23% relative reduction in risk for ischemic stroke. There were no increases in major hemorrhages, hemorrhagic stroke, or myocardial infarction.
This study, which was conducted in Chinese patients, offers a strong argument for short-term, dual-antiplatelet therapy in patients with TIA or minor strokes. Whether the same results would be obtained in a different population is not known. We have to wait for the results of the POINT trial, which is being conducted in the United States and Canada and will be finalized in the next 18 months. For now, using a combination of aspirin and clopidogrel for about 3 weeks before switching to monotherapy is an option, at least.
1. Wang Y, Zhao X, Wang D, et al. Clopidogrel and aspirin versus aspirin alone for the treatment of high-risk patients with acute non-disabling cerebrovascular event (CHANCE): a randomized, double-blind, placebo-controlled multicenter trial. Program and abstracts of the 2013 International Stroke Conference; February 6-8, 2013; Honolulu, Hawaii. Abstract LB11.
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Cite this article: Secondary Stroke Prevention: Are 2 Meds Better Than 1? Medscape. Mar 07, 2013.

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