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Addition of Aspirin to Clopidogrel Has No Benefit for Patients at High Risk of Repeat Stroke or Ischemic Attack: Presented at ESC
Michael J. Worthington
MANNHEIM-HEIDELBERG, GERMANY -- May 14, 2004 -- There is no advantage to adding aspirin (acetylsalicylic acid, ASA) to clopidogrel for preventing a second stroke in patients who have already experienced a transient ischemic attack (TIA) or ischemic stroke, but the combination significantly increases their risk of serious and life-threatening hemorrhage.
These were the key results of the long-awaited Management of Athrombosis with Clopidogrel in High Risk Patients with Recent Transient Ischemic Attack or Ischemic Stroke (MATCH) trial, reported for the first time here on May 13th at the 13th European Stroke Conference. Hans-Christoph Diener, MD, Professor of Neurology, Universitat Essen, Germany, and principal investigator of the MATCH trial presented the findings.
Clopidogrel became a popular treatment for ischemic prevention after the Clopidogrel vs Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial showed it has an advantage over aspirin in preventing a range of cardiovascular ischemic events, including myocardial infarction (MI), ischemic stroke, or vascular death.
The objective of the MATCH trial was to assess whether the addition of ASA to clopidogrel and other standard therapies would provide further clinical benefit for patients at risk of recurrent stroke.
The MATCH trial enrolled 7599 patients who were 40 years of age and had a history of TIA (21.1%) or ischemic stroke (78.9%) and other markers of high risk, such as hypertension, previous MI, symptomatic peripheral artery disease, angina, or diabetes.. Patients were randomized to add ASA 75 mg or placebo to their background prophylactic clopidogrel therapy. Double-blind treatment and follow-up lasted for 18 months.
Results showed that the addition of ASA had a limited, nonsignificant effect on ischemic events: 15.7% of patients taking ASA had a further ischemic event (i.e. MI, ischemic stroke, vascular death, or rehospitalization for an acute ischemic event) versus 16.73% of patients on placebo (relative risk reduction = 6.4%; P = .244).
In addition, patients taking ASA experienced more significant, life-threatening hemorrhage compared to patients taking placebo (2.6% versus 1.3%, respectively; P < .001).
"Given these results, combination therapy with clopidogrel and ASA cannot be recommended in patients with TIA or stroke and at high risk for recurrence," Prof. Diener said.
He noted that monotherapy with 1 of 3 agents (i.e. clopidogrel, ASA, or ASA/extended release dipyridamole) is the preferred approach for this particular patient population.
Presentation title: "Antiplatelet therapy: results of the MATCH trial"
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