A Combintion Of Drugs May Reduce Risk of Second Stroke

 After suffering a stroke or a mini-stroke, patients are usually given aspirin to prevent clots that can cause another stroke. Now a new study suggests that adding the drug Plavix (clopidogrel) to the mix can reduce the risk of a second stroke by nearly a third over aspirin alone.

Both drugs target clotting agents in the blood, called platelets, preventing them from grouping together and forming clots. The drug combination is commonly used after a heart attack, but until now there hasn't been enough data to suggest it would work in stroke or mini-stroke, officially known as a transient ischemic attack (TIA).

Most strokes are caused by blood clots that block blood vessels in the brain. These are called ischemic strokes. A TIA is also caused by a clot that dissipates in a short time. Both leave patients at risk for another stroke that could be more severe, the researchers said.

In the new phase 3 trial, more than 5,000 patients who had suffered a stroke or TIA within the previous 24 hours were randomly assigned to take either aspirin alone or aspirin plus Plavix for three months.

This three-month period is the most critical for repeat strokes, with 10 percent to 20 percent of people who have a TIA or minor stroke suffering a second stroke, the researchers said.

Within three months of starting the study, 8.2 percent of the patients taking the two-drug combo had another stroke, compared with 11.7 percent of those taking aspirin alone, the researchers found.

Recently, doctors have moved away from using this combination of drugs for long-term stroke treatment because of the increased risk of serious bleeding, he said.

"Now we can see there is a definite benefit of the combined use of aspirin and Plavix in the acute phase of stroke,".

He said this treatment appears most effective in patients who have suffered a minor stroke or TIA. "If the results of other trials are similar to what we saw in this one, more people will use this therapy," he said. "It offers more tools and better options to offer patients."  He also noted that TIA patients are at a high risk for stroke.

The drug combination has not been found effective in long-term treatment to prevent a second stroke. However, he added, "this trial offers hope that in the short term, combination [drugs] may be worth the increased bleeding risk to improve outcomes."

Stroke is a major cause of death and disability around the world, and the fourth leading cause of death in the United States.

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