Dual antiplatelet therapy with clopidogrel and aspirin for stroke prevention following transient ischemic attack (TIA) or mild-to-moderate ischemic stroke

Introduction: Patients who have transient ischemic attack (TIA) or ischemic stroke are at a high risk of having a first or recurrent stroke. Secondary prevention includes antithrombotic therapy, treatment of risk factors, and interventional treatment of carotid stenosis. The merits of antiplatelet therapy with different protocols in primary and secondary stroke prevention have been demonstrated across numerous trials which lead to somewhat contradictory findings. Our objective was to compare the effects of aspirin, clopidogrel, and clopidogrel plus aspirin in the prevention of recurrent stroke. Methods: Ninety-two patients with TIA or minor ischemic stroke were randomly assigned in three groups: Group A (aspirin, 80-100 mg/day; 29 patients), group B (clopidogrel, 75 mg/day; 31 patients) and group C (clopidogrel 75 mg/day plus aspirin 80-100 mg/day; 32 patients). All patients were followed for a period of 18 months. Rather than demographic data, the number of new attacks and the time it occurs were recorded for each patient. Kaplan-Meier analysis was performed to compare the median time to stroke outcome in each group. Results: The patients were 53 (57.6%) male and 39 (42.4%) female with the mean age of 65.47(SD=8.36) year which was not significantly different in three groups of study (P>0.05). After 18 months of follow-up, the mortality rate was 13.8%, none and 3.1% in groups A, B and C, respectively. The mean number of attacks was significantly lower in group C [0.63(standard deviation (SD)=0.49)] than groups A [1.59(SD=0.95)] and B [0.81(SD=0.65)] (P<0.001). Moreover, the mean time to stroke outcome was significantly longer in group C [16.12(Standard error (SE)=0.57) month] than groups A [6.76(SE=1.21) month] and B [13.71(SD=1.02) month] (Log rank P<0.001). Conclusion: Antiplatelet therapy is effective in secondary stroke prevention. Current recommendations are applied in clinical practice, but great variability between different centers remains. Our results showed that aspirin combined use with clopidogrel have better efficacy and decreased rate of recurrence in patients with TIA or minor ischemic stroke in this single-center study.