Comparison of clopidogrel plus aspirin versus aspirin alone in acute mild to moderate stroke

A recent study found that in patients experiencing acute mild to moderate ischemic stroke, the combination of clopidogrel and aspirin proved more effective in reducing early neurologic deterioration at 7 days compared to aspirin alone while maintaining a similar safety profile. These results suggest that dual antiplatelet therapy could be a more advantageous treatment option for patients with acute mild to moderate stroke. This study’s results were published in the JAMA Neurology journal.

In this multicenter, randomized, open-label, clinical trial, a total of 3000 patients with acute mild to moderate stroke within 48 hours of symptom onset were included. The patients were randomly assigned to two groups: one group received a combination of clopidogrel and aspirin (n = 1541), while the other group received aspirin alone (n = 1459). The primary endpoint of the trial was early neurologic deterioration at 7 days, which was defined as an increase of 2 or more points in the National Institutes of Health Stroke Scale (NIHSS) score, excluding cases of cerebral hemorrhage, compared to the baseline. Safety end points included bleeding events.

The modified intention-to-treat analysis included a total of 2915 patients. Within the dual antiplatelet therapy group, 72 out of 1502 patients (4.8%) experienced early neurologic deterioration, compared to 95 out of 1413 patients (6.7%) in the aspirin alone group (the risk difference was -1.9%). Additionally, there were no significant differences in bleeding events observed between the two groups.

Thus, it can be concluded that in individuals with acute mild to moderate ischemic stroke, the use of both clopidogrel and aspirin was found to be superior in decreasing early neurologic deterioration at 7 days when compared to aspirin alone, exhibiting a similar safety profile.