A recent study published in the New England Journal of Medicine has brought significant advancements in the treatment of mild ischemic stroke and high-risk transient ischemic attack (TIA) patients.
Conducted by Dr. Ying Gao and colleagues from Beijing Tiantan Hospital, the research highlights the benefits of combined clopidogrel-aspirin therapy when initiated within 72 hours after the onset of stroke symptoms.
The study was a randomized two-by-two factorial trial, involving patients who had not undergone thrombosis or thrombectomy.
Patients were assigned either to a clopidogrel plus aspirin group or to a group receiving a matching clopidogrel placebo plus aspirin. Each group comprised 3,050 patients, and the treatment was started within 72 hours of symptom onset.
The results were compelling. The clopidogrel-aspirin combination group showed a lower incidence of new strokes within 90 days, with 7.3% of patients experiencing a new stroke compared to 9.2% in the aspirin-only group.
This translates to a hazard ratio of 0.79, indicating a significant reduction in stroke risk with the dual therapy.
However, the study also noted an increased risk of moderate-to-severe bleeding in the clopidogrel-aspirin group (0.9%) compared to the aspirin group (0.4%), with a hazard ratio of 2.08. This highlights the need for careful patient selection and monitoring during treatment.
An accompanying editorial in the journal emphasized the importance of this trial, suggesting that the time window for dual antiplatelet therapy could be extended to 72 hours.
The editorial also stressed the necessity of administering a loading dose of clopidogrel as soon as possible within this timeframe to maximize the therapy’s effectiveness.
This study, partially funded by Sanofi and Beijing Jialin Pharmaceutical, marks a pivotal step in stroke management, potentially changing treatment protocols for patients with mild ischemic stroke or high-risk TIA.
It underscores the delicate balance between reducing stroke risk and managing bleeding complications in dual antiplatelet therapy, guiding clinicians towards more informed and effective treatment strategies.
If you care about stroke, please read studies about Half of people with heart rhythm diseases dying of heart attack, stroke and findings of New method reduces heart attacks and strokes over five years.
For more information about health, please see recent studies about how Mediterranean diet could protect your brain health, and wild blueberries can benefit your heart and brain.
The research findings can be found in New England Journal of Medicine.
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