Antiplatelet therapy with clopidogr...

Antiplatelet therapy with clopidogrel has provided significant secondary prevention for patients with transient ischemic attacks (TIA) and ischemic knock The effect was superior to aspirin and varied with the subgroup of patients studied. In the international Management of Atherothrombosis with Clopidogrel in High-Risk Patients (MATCH) close attention Diener and colleagues studied the result of adding aspirin to clopidogrel in the preven-tion of vascular events

More than 7500 patients 40 years or older were recorded at 507 centers in 28 countries. Participants had sustained an ischemic visitation or TIA within the previous three month and had at least the same additional risk factor (e.g., previous ischemic hardship or myocardial infarction, angina, diabetes, or symptomatic peripheral vascular disease). Exclusions included enhanced risk of bleeding complications and any contraindication to the inquiry medications. All participants were receiving 75 mg of clopidogrel daily. After assessment, participants were assigned randomly to receive 75 mg of aspirin or an identical placebo in addition to their other medications. Participants were reassessed after single three, six, 12, and 18 month The principal endpoint was a serious vascular circumstance defined as ischemic stroke, myocardial infarction, vascular death, or hospital admission for a vascular issue Other end-points included death or thump Patients were monitored for any serious bleeding or adverse general intent of treatment.

The 3802 patients assigned to clopidogrel plus placebo were similar to the 3797 patients assigned to clopidogrel plus aspirin. Women comprised 37 percent of each assign places to Previous ischemic stroke was reported through 26 percent of participants, TIA by means of 19 percent, hypertension by 78 percent diabetes by means of 68 percent, and elevated cholesterol flats by 56 percent. One additional risk factor was reported according to 79 percent of participants, and brace or more risk factors were reported by the agency of 20 percent. In the assign places to receiving aspirin plus clopidogrel, 596 patients (157 percent) reached a primary endpoint compared with 636 patients (167 percent) who received clopidogrel plus placebo. The absolute risk reduction of 1 percent was not statistically significant. reciprocally significantly more bleeding complications occurr in patients taking the one and the other medications (see accompanying table). Life-threatening bleeding occurr in 96 patients (3 percent) receiving aspirin plus clopidogrel, compared with 49 patients (1 percent) receiving clopidogrel plus placebo. Patients receiving clopidogrel plus aspirin also had more minor bleeding (3 versus 1 percent) Gastro-intestinal bleeding was the chiefly common cause of life-threatening bleeding.

The authors close that although adding aspirin to clopidogrel was associated with a small decrease in major vascular affairs this benefit was countered through a significant increase in bleeding complications, including life-threatening bleeding.

Diener HC et al. Aspirin and clopidogrel compared with clopidogrel alone after fresh ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet July 24 2004:364:331-7

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