- Among patients with transient ischemic attack (TIA) or minor acute ischemic stroke, short-term risk for major hemorrhage with antiplatelet therapy was low overall, but higher when clopidogrel (Plavix, others) was added to aspirin.
Why this matters
- TIA and minor acute ischemic stroke carry elevated risk for new ischemic stroke, especially in early period.
- Aspirin is current standard of care.
- Incidence of major hemorrhage: 0.9% with clopidogrel plus aspirin, 0.2% with placebo plus aspirin (HR, 3.57; P=.003).
- Number needed to harm: 159.
- 4 fatal hemorrhages (0.1%):
- 3 with clopidogrel plus aspirin (0.1%),
- 1 with placebo plus aspirin (0.1%).
- 7 intracranial hemorrhages (0.1%):
- 5 with clopidogrel plus aspirin (0.2%),
- 2 with placebo plus aspirin (0.1%).
- Most common major hemorrhage location: gastrointestinal tract.
- Secondary analysis of POINT multinational randomized controlled trial among 4881 patients with high-risk TIA or minor acute ischemic stroke, all given open-label aspirin (50-325 mg/day).
- Randomization within 12 hours of symptom onset: clopidogrel (600-mg loading dose on day 1, then 75 mg daily for days 2-90) vs placebo.
- Main outcome: major hemorrhage during mean 90-day follow-up.
- Funding: National Institute of Neurological Disorders and Stroke; Sanofi.
- Small number of major hemorrhages.
- Longer-term outcomes unclear.