Combination anti-clotting therapy raises bleeding risk for people at high risk of recurrent stroke


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The combination of two anti-clotting agents, aspirin and clopidogrel-- known to be beneficial for people with cardiovascular disease--should not be recommended treatment for patients who have cerebrovascular disease, conclude authors of a study in this week's issue of THE LANCET.

Hans-Christoph Diener (University of Essen, Germany) and colleagues compared the effects of adding aspirin or placebo to patients already taking clopidogrel because they had a previous history of ischaemic stroke (stroke caused by a blood clot) or transient ischaemic attack. Around 7600 patients received either placebo or aspirin on top of existing clopidogrel therapy. After 18 months treatment and follow-up, there was a small (1%) but statistically insignificant reduction in the primary outcome measure of the study--a composite of heart attack, ischaemic stroke, death due to vascular causes, and hospitalisation for ischaemic stroke--among patients given aspirin in addition to clopidogrel; however, this combination of anti-clotting agents doubled the risk of intracranial and gastrointestinal bleeding from 1.3% to 2.6%, off-setting any potential benefit of combination treatment.

In an accompanying commentary (p 305) Peter Rothwell (University of Oxford, UK) concludes: "In summary, MATCH has shown that compared with clopidogrel alone, the risk of major bleeding with the addition of aspirin outweighs any benefit at 18 months. Patients with previous TIA or stroke who are currently taking aspirin and clopidogrel should be advised of the risk".

Source: Eurekalert & others

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