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    Home » Dual Antiplatelet Therapy for Acute Ischemic Stroke and TIA
    STROKE ALERT

    Dual Antiplatelet Therapy for Acute Ischemic Stroke and TIA

    September 1, 2018
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    Keywords

    stroke

    aspirin

    antiplatelet

    clopidogrel

    By Matthew E. Fink, MD

    Professor and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital

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

    SOURCE: Johnston SC, Easton JD, Farrant M, et al; Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network and the POINT Investigators. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med 2018;379:215-225.

    In a recent study of a Chinese population, early treatment with dual antiplatelet medications demonstrated a reduction in the risk of recurrent stroke. The POINT trial included an international population to test the hypothesis that early treatment of minor ischemic stroke or high-risk transient ischemic attack (TIA) with a combination of clopidogrel and aspirin would be better than aspirin alone in reducing the incidence of recurrent ischemic stroke at 90 days. POINT was a randomized trial that enrolled 4,881 patients at 269 sites. The trial was halted early after 84% of the anticipated number of patients were enrolled, because an interim analysis showed that the combination of clopidogrel and aspirin was associated with a lower risk of major ischemic events but a higher risk of major hemorrhage than aspirin alone at 90 days.

    Major ischemic events occurred in 5% of patients receiving clopidogrel plus aspirin and in 6.5% of patients receiving aspirin plus placebo (hazard ratio, 0.75; P = 0.02). Most of the recurrent ischemic events occurred during the first week following initial event. Major hemorrhages occurred in 0.9% of patients receiving dual antiplatelet therapy and 0.4% of patients receiving aspirin plus placebo. The most feared complication, symptomatic intracerebral hemorrhage, was rare in both groups, and there were only two cases in each group (0.1%). Most serious hemorrhages that occurred were related to gastrointestinal bleeding. Although dual antiplatelet therapy conferred modest benefit regarding recurrent ischemic events, the increased risk of serious hemorrhages must be taken into account when making therapeutic decisions to use these medications in combination.

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    Neurology Alert

    View PDF
    Neurology Alert (Vol. 38, No. 1) - September 2018
    September 1, 2018

    Table Of Contents

    Which Is Better for Nonconvulsive Seizures: Lacosamide or Fosphenytoin?

    Initial Management of Patients With Medication-overuse Headache

    Unilateral Scapular Winging

    Hypercapnic Acidosis and Clinical Outcomes in Patients With Acute Brain Injury

    Recanalization Treatment in Pediatric Arterial Ischemic Stroke

    Atrial Flutter, Atrial Fibrillation, and Ischemic Stroke

    Dual Antiplatelet Therapy for Acute Ischemic Stroke and TIA

    Treatment of Chronic Subdural Hematoma With Atorvastatin

    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.

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