Relias Media - Continuing Medical Education Publishing

The trusted source for

healthcare information and

CONTINUING EDUCATION.

  • Sign In
  • Sign Out
  • MyAHC
    • Home
      • Home
      • Newsletters
      • Blogs
      • Archives
      • CME/CE Map
      • Shop
    • Emergency
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Hospital
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Clinical
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • All Access
      • My Subscription
      • Subscribe Now
    • My Account
      • My Subscriptions
      • My Content
      • My Orders
      • My CME/CE
      • My Transcript
    Home » Dual Antiplatelet Therapy for Minor Ischemic Stroke or TIA
    STROKE ALERT

    Dual Antiplatelet Therapy for Minor Ischemic Stroke or TIA

    July 1, 2018
    No Comments
    Reprints
    Facebook Twitter Linkedin Share Share

    Related Articles

    Dual Antiplatelet Therapy Results in Increase in Serious Hemorrhages Following TIA or Minor Stroke

    Dual Antiplatelet Therapy for Acute Ischemic Stroke and TIA

    Dual Antiplatelet Therapy Increases Serious Hemorrhages Following TIA or Minor Stroke

    Related Products

    Optimal Antiplatelet Therapy for Secondary Prevention of Ischemic Stroke

    Functional Outcomes in Acute Ischemic Stroke Patients Receiving Prehospital Thrombolysis in Mobile Stroke Units

    Keywords

    stroke

    aspirin

    clopidogrel

    By Matthew E. Fink, MD

    Feil Professor & Chair of Neurology, Associate Dean for Clinical Affairs, NYP/Weill Cornell Medical College

    Dr. Fink reports he is a retained consultant for Procter & Gamble and Pfizer.

    SOURCE: Johnston SC, Easton JD, Farrant M, et al; for the Clinical Research Collaboration, Neurological Treatment Trials Network, and the POINT Investigators. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med 2018; May 16. doi:10.1056/NEJMoa1800410. [Epub ahead of print].

    After a minor ischemic stroke or transient ischemic attack (TIA), the risk of recurrent ischemic stroke in the next 90 days ranges from 3-15%. Use of aspirin reduces the risk of recurrent stroke by approximately 20%. Clopidogrel inhibits platelet aggregation in a mechanism that is synergistic with aspirin when tested in platelet aggregation assays. The combination of these two drugs has been used effectively to reduce the risk of ischemic events in patients with coronary artery events. These investigators undertook this study to evaluate the effect of clopidogrel plus aspirin, vs. aspirin alone, in an international population of patients who had minor ischemic stroke or TIA — Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT).

    From 2010 to 2017, the investigators enrolled 4,881 patients at 269 sites in 10 countries in North America, Europe, Australia, and New Zealand, with most patients (82.8%) enrolled in the United States. After an interim analysis, the investigators halted enrollment after 84% of the anticipated number of patients had been enrolled because the combination of clopidogrel and aspirin was associated with both a lower risk of major ischemic events (ischemic stroke, myocardial infarction, or death from an ischemic vascular event) and a higher risk of major hemorrhage from aspirin alone at 90 days. Five percent of patients receiving clopidogrel plus aspirin and 6.5% of patients receiving aspirin plus placebo (hazard ratio, 0.75; P = 0.02) experienced major ischemic events, with most occurring during the first week after the initial event. Major hemorrhages occurred in 0.9% receiving clopidogrel plus aspirin and 0.4% receiving aspirin plus placebo (hazard ratio, 2.32; P = 0.02). Hemorrhage risk was the same throughout the 90-day follow-up period.

    The investigators were unable to compare the disabilities that resulted from ischemic events compared to hemorrhagic events, but mortality was not significantly different between the two groups. Based on this study and the CHANCE trial from China (N Engl J Med 2013;369:11-19), a reasonable approach for treatment would be 30 days of treatment with dual antiplatelet therapy following acute ischemic stroke or TIA, and then
    conversion to a single agent. However, such recommendations are my opinion, and not based on evidence from any study.

    Post a comment to this article

    Report Abusive Comment

    www.reliasmedia.com

    Neurology Alert

    View PDF
    Neurology Alert (Vol. 37, No. 11) - July 2018
    July 1, 2018

    Table Of Contents

    Predicting the Risk of Late-onset Alzheimer’s Disease and Dementia Based on Common Genetic Variants

    Ufmylation and Brain Development: Effects of Gene Mutations

    Cannabidiol: Does It Help in Drug-resistant Epileptic Encephalopathies?

    Chemotherapy-induced Neuropathy in Childhood Cancer Survivors

    Prodromal Symptoms Predict the Onset of α-Synucleinopathies

    Dual Antiplatelet Therapy for Minor Ischemic Stroke or TIA

    Tenecteplase vs. Alteplase for Ischemic Stroke

    Begin Test

    Buy this Issue/Course

    Financial Disclosure: Neurology Alert’s Editor in Chief Matthew Fink, MD; Peer Reviewer M. Flint Beal, MD; Executive Editor Leslie Coplin; Editor Jonathan Springston; and Editorial Group Manager Terrey L. Hatcher report no financial relationships relevant to this field of study.

    Shop Now: Search Products

    • Subscription Publications
    • Books & Study Guides
    • Webinars
    • Group & Site
      Licenses
    • State CME/CE
      Requirements

    Webinars And Events

    View All Events
    • Home
      • Home
      • Newsletters
      • Blogs
      • Archives
      • CME/CE Map
      • Shop
    • Emergency
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Hospital
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Clinical
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • All Access
      • My Subscription
      • Subscribe Now
    • My Account
      • My Subscriptions
      • My Content
      • My Orders
      • My CME/CE
      • My Transcript
    • Help
    • Search
    • About Us
    • Sign In
    • Register
    Relias Media - Continuing Medical Education Publishing

    The trusted source for

    healthcare information and

    CONTINUING EDUCATION.

    Customer Service

    customerservice@reliasmedia.com

    U.S. and Canada: 1-800-688-2421 x 2

    International +1-404-262-5476 x 2

    Accounts Receivable

    1-800-688-2421 x 3
    ReliasMedia_AR@reliasmedia.com

    Sales

    1-800-688-2421 x 1

    Mailing Address

    • 1010 Sync St., Suite 100
      Morrisville, NC 27560-5468
      USA

    © 2022 Relias. All rights reserved.

    Do Not Sell My Personal Information  Privacy Policy  Terms of Use  Contact Us  Reprints  Group Sales

    For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, DPO@relias.com

    Design, CMS, Hosting & Web Development :: ePublishing