A new clinical trial called POINT and funded by the US National Institute of Health (NIH) has demonstrated positive outcomes in some stroke patients treated with a combination of aspirin and clopidogrel.
After a small stroke or minor stroke symptoms, patients administered with the combination therapy were found to have experienced reduced risk of a secondary stroke, heart attack or other ischemic event within 90 days.
However, it was observed that the therapy led to an increase in major bleeding episodes, most of which were non-fatal and did not occur in the brain.
NIH National Institute of Neurological Disorders and Stroke director Walter Koroshetz said: “These findings are likely to have a global effect on clinical practice, as these drugs are easily available in many hospitals and clinics.
“As the benefit of the combination was concentrated in the first two weeks while risk of bleeding was constant over 90 days, it may be especially valuable in acute management of a minor ischemic stroke or transient ischemic attack (TIA).”
The trial recruited more than 4,880 patients who had a minor stroke or a TIA and compared the combination with aspirin alone.
While aspirin blocks molecules activating the clotting process, clopidogrel prevents a specific chemical from attaching to a receptor.
The study revealed that the combination of aspirin with clopidogrel prevented more ischemic events.
Of the total participants, 5% treated with the combination experienced an ischemic event within three months, compared to 6.5% treated with only aspirin.
Whereas 0.9% subjects administered with aspirin and clopidogrel experienced severe bleeding versus 0.4% of patients in aspirin-only arm who had a major haemorrhage.
Lead author of the study dean and professor of neurology at Dell Medical School, University of Texas, Austin, S Claiborne Johnston said: “We saw a real benefit with the combination therapy, but that treatment does come with a risk. Overall, the risk of severe bleeding was very small, but it was not zero.”
Based on the findings, the researchers concluded that for 1,000 patients, the combination would prevent 15 ischemic attacks but may result in five instances of major haemorrhage.