Source: Cerebrovasc Dis  |  Posted 8 years ago

A recent review article highlights the idea that antiplatelet combination therapy using agents with different mechanisms of action is useful for preventing ischaemic stroke.

Luis A. Urbano, MD, and Julien Bogousslavsky, MD, department of neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, describe recently completed and ongoing studies using combined agents.

Final results from the recently completed European Stroke Prevention Study 2 (ESPS-2) showed a relative risk reduction of 22% with the combination of aspirin and dipyridamole versus aspirin alone.

The authors point out that clopidogrel is an effective and safe alternative in patients who do not tolerate aspirin, in diabetics, in hypercholesterolaemic patients and in those who have undergone previous cardiac surgery.

Studies demonstrated that therapy with clopidogrel and aspirin provides synergistic antiplatelet effects. For example, the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) and PCI-CURE trials showed its efficacy in reducing relative risk among patients with unstable angina or non-Q-wave myocardial infarction, whether or not they undergo a percutaneous coronary intervention.

The CURE trial evaluated efficacy and safety of clopidogrel when given together with aspirin in 12,562 patients with acute coronary syndromes and no ST segment elevation. Its findings showed a 20% reduced risk of nonfatal myocardial infarction or stroke when aspirin was combined with clopidogrel as rather than placebo.

Likewise, the PCI-CURE trial evaluated a subset of 2,658 patients undergoing percutaneous coronary intervention. In these patients, cardiovascular death or myocardial infarction were reduced by 31% ([]P[] = .002) in the clopidogrel group compared to the placebo group.

The researchers conclude that "antiplatelet combination therapy using agents with different mechanisms of action is an attractive approach" that is being evaluated in a number of ongoing studies