Abstract
Our objective was to investigate whether clopidogrel added to low-dose aspirin reduced
vascular events in male patients at our VA hospital who had “failed” aspirin therapy
because of a mild-to-moderate stroke or a transient ischemic attack. Of 179 consecutive
patients who both reported daily aspirin usage at the time of their newest ischemic
event as well as were then operationally defined as aspirin “failures,” 134 (group
A) were treated with combined aspirin-clopidogrel, 15 (group B) underwent an early
arterial procedure, 25 (group C) were anticoagulated, and 5 were not entered or continued
because of either non-compliance or a refusal to participate. Study therapies were
modified because of a vascular event in 4.5% of group A (one non-fatal ischemic stroke,
one non-fatal myocardial infarction, and four transient ischemic attacks) and 33%
of group B (one non-fatal ischemic stroke, one non-fatal myocardial infarction, and
three transient ischemic attacks). No major or fatal bleeding events occurred in any
of those on combined aspirin-clopidogrel therapy, with minor bleeding in 10 of 134
(7.5%) and 2 of 15 (13.3%) of group A and B patients, respectively. Patients were
followed for 18 ± 9.7 months. Combined aspirin-clopidogrel therapy appears both safe
as well as effective in this single-center, observational study. Copyright © 2003
by National Stroke Association
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Antithrombotic and thrombolytic therapy for ischemic stroke.Chest. 2001; 119: 300S-320S
- Advances in long-term stroke prevention with antiplatelet therapy.J Stroke Cerebrovasc Dis. 2001; 10: 18S-23S
- A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE).Lancet. 1996; 348: 1329-1339
- Number of major vascular events prevented by clopidogrel versus other cardiovascular therapies.Neurology. 1998; 51 (abstr): 332S
- Special edition: a review of antiplatelet agents meta-analysis. National Stroke Association.Stroke: Clinical Updates. 1998; 8: 1-6
- Clopidogrel and its use in stroke patients (letter).Stroke. 1998; 29: 1737
- Current strategies of secondary prevention after a cerebrovascular accident.Stroke. 2001; 32: 2860-2866
- Classification of subtype of acute ischemic stroke. Definition for use in a multicenter clinical trial.Stroke. 1993; 24: 35-41
- Cerebral vascular accidents in patients over the age of 60: II Prognosis.Scot Med J. 1957; 2: 200-215
- Interrater reliability of the NIH Stroke Scale.Arch Neurol. 1989; 46: 660-662
- Mechanism of stroke in patients taking aspirin.Neurology. 1990; 40: 1682-1685
- Aspirin response and failure in cerebral infarction.Stroke. 1993; 24: 345-350
- Development of aspirin resistance in persons with previous ischemic stroke.Stroke. 1994; 25: 2331-2336
- Profile and prevalence of aspirin resistance in patients with cardiovascular disease.Am J Cardiol. 2001; 88: 230-235
- Compliance with secondary prevention of ischemic stroke. A prospective evaluation.Stroke. 2001; 32: 1884-1889
- Combination therapy with low-dose aspirin and ticlopidine in cerebral ischemia.Stroke. 1989; 20: 1643-1647
- A randomized comparison of combined ticlopidine and aspirin therapy versus aspirin therapy alone after successful intravascular ultrasound-guided stent implantation.Circulation. 1996; 93: 215-222
- Early potent antithrombotic effect with combined aspirin and a loading dose of clopidogrel on experimental arterial thrombogenesis in humans.Circulation. 2000; 101: 2823-2828
- Ticlopidine versus aspirin for the prevention of recurrent stroke. Analysis of patients with minor stroke from the Ticlopidine Aspirin Stroke Study.Stroke. 1992; 23: 1723-1727
- A randomized trial of aspirin and sulfinpyrazone in threatened stroke.N Engl J Med. 1978; 299: 53-59
- “AICLA” controlled trial of aspirin and dipyridamole in the secondary prevention of atherothrombotic cerebral ischemia.Stroke. 1983; 14: 5-14
- Acetylsalicylic acid in the prevention of stroke in patients with reversible cerebral ischemic attacks: a Danish cooperative study.Stroke. 1983; 14: 15-22
- A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients.N Engl J Med. 1989; 321: 501-507
- Does platetelet antiaggregant therapy lessen the severity of stroke?.Neurology. 1985; 35: 632-636
- Antiplatelet treatment does not reduce the severity of subsequent stroke.Neurology. 1999; 53: 825-829
- Effect of prior aspirin use on stroke severity in the Trial of Org 10172 in Acute Stroke Treatment (TOAST).Stroke. 2001; 32: 2836-2840
- Failure of aspirin treatment after stroke.Stroke. 1994; 25: 275-277
- A double-blind randomized comparison of combined ticlopidine and aspirin therapy versus aspirin or ticlopidine alone on experimental arterial thrombogenesis in humans.Blood. 1998; 92: 1518-1525
- Antithrombotic therapy in patients undergoing coronary angioplasty.Chest. 1998; 114: 728S-741S
- Clopidogrel inhibition of stent, graft, and vascular thrombogenesis with antithrombotic enhancement by aspirin in nonhuman primates.Circulation. 1998; 98: 2461-2469
- The antiaggregating and antithrombotic activity of clopidogrel is potentiated by aspirin in several experimental models in the rabbit.Thromb Haemost. 1998; 80: 512-518
- Effects of clopidogrel, aspirin, and combined therapy in a porcine ex vivo model of high-shear induced stent thrombosis.Eur Heart J. 1998; 19: 1538-1546
- Effect of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation.N Engl J Med. 2001; 345: 494-502
- Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study.Lancet. 2001; 358: 527-533
- Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation.Circulation. 1999; 99: 2364-23366
- Combination aspirin-clopidogrel therapy in patients with ischemic stroke.Stroke. 2000; 31 (abstr): 298
- Combination therapy with clopidogrel and aspirin. Can the CURE results be extrapolated to cerebrovascular patients?.Stroke. 2001; 32: 2948-2949
Article info
Publication history
Accepted:
November 12,
2002
Received:
September 6,
2002
Footnotes
*Address reprint requests to: Ross L. Levine, MD, Neurology Service/127, Middleton VAH, 2500 Overlook Tr., Madison, WI 53705.
Identification
Copyright
© 2003 National Stroke Association. Published by Elsevier Inc. All rights reserved.
