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Evolving Perspectives on Clopidogrel in the Treatment of Ischemic Stroke

Department of Neurology and Center for Stroke Research, University of Illinois College of Medicine at Chicago, pgorelic{at}uic.edu

Oksana Sechenova, RPh

Bethesda Hospital, Boynton Beach, Florida

Charles H. Hennekens, MD, DrPH

Department of Biomedical Science, Center of Excellence, Florida Atlantic University, Boca Raton, Department of Medicine and Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida

Antiplatelet therapy is indicated for the treatment of ischemic stroke or transient ischemic attack (TIA). Aspirin reduces subsequent occlusive vascular events, including recurrent stroke, by about 25%. In such patients, clopidogrel has been evaluated in an effort to further reduce risk. In the Management of Atherothrombosis with Clopidogrel in High-risk Patients trial, the combination of clopidogrel plus aspirin was compared with clopidogrel alone, and the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance trial tested the addition of clopidogrel to aspirin. Combination therapy with aspirin plus clopidogrel provided no significant incremental benefit compared with aspirin or clopidogrel alone. In addition, combination therapy increased the risk of serious bleeding. On the basis of the current totality of evidence for long-term treatment of survivors of ischemic stroke or TIA, clopidogrel is an effective alternative for patients who are intolerant to aspirin.

Key Words: antiplatelet therapy • aspirin • CHARISMA • clopidogrel • ischemic stroke • MATCH

References

• American Heart Association. Heart disease and stroke statistics—2006 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006;113:e85-e151.
• Sacco RL, Adams R, Albers G, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke. Cosponsored by the Council on Cardiovascular Radiology and Intervention. The American Academy of Neurology affirms the value of this guideline. Stroke. 2006;37:577-617.[Abstract/Free Full Text]
• Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324:71-86.[Abstract/Free Full Text]
• Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331-337.[CrossRef][ISI][Medline] [Order article via Infotrieve]
• Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354:1706-1717.[Abstract/Free Full Text]
• Bhatt DL, Topol EJ. Clopidogrel added to aspirin versus aspirin alone in secondary prevention and high-risk primary prevention: rationale and design of the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial. Am Heart J. 2004;148:263-268.[CrossRef][ISI][Medline] [Order article via Infotrieve]
• Pfeffer MA, Jarcho JA. The charisma of subgroups and the subgroups of CHARISMA. N Engl J Med. 2006;354: 1744-1746.[Free Full Text]
• Hennekens CH, Buring JE. Epidemiology in MedicineBoston: Little, Brown, and Company; 1987.
• Lagakos SW. The challenge of subgroup analyses—reporting without distorting. N Engl J Med. 2006;354: 1667-1669.[Free Full Text]
• Diener HC, Cunha L, Forbes C, Sivenius J, Smets P, Lowenthal A. European Stroke Prevention Study 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996;143:1-13.[CrossRef][ISI][Medline] [Order article via Infotrieve]
• Halkes PH, van Gijn J, Kappelle LJ, Koudstaal PJ, Algra A. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet. 2006;367:1665-1673.[CrossRef][ISI][Medline] [Order article via Infotrieve]

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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gorelick, P. Articles by Hennekens, C. H. Search for Related Content PubMed PubMed Citation Articles by Gorelick, P. Articles by Hennekens, C. H. Social Bookmarking                   What's this?