Dual Antiplatelet Therapy May Lower Stroke Risk by 25% in High-Risk Patients  | NEJM


Key Points

  • Clopidogrel + aspirin lower risk of major ischemic events (stroke, MI, vascular) relative to aspirin alone following minor stroke or high-risk TIA
  • Most risk reduction during first 30 days
  • More frequent serious bleeding events on dual therapy, although primarily gastrointestinal/systemic rather than intracerebral
  • Dual therapy benefit may outweigh risks in first 30 days after minor stroke/TIA


  • Risk of ischemic stroke 3-15% in 90 days after minor ischemic stroke or TIA
  • Clopidogrel blocks platelet aggregation through the P2Y12-receptor pathway
  • Aspirin is a cyclooxygenase inhibitor with antiplatelet activity
  • Clopidogrel + Aspirin reduce risk of ischemic events in ACS
  • CHANCE trial showed 32% lower risk of stroke recurrence after a minor ischemic stroke/TIA with clopidogrel/aspirin combo in China (no increased risk of hemorrhage)


  • Randomized-controlled trial, double-blind
  • NINDS-funded, Sartoli provided clopidogrel
  • 269 sites in 10 countries, mostly in USA
  • 4881 patients, 12 hours after 1-4 on NIHSS scale (stroke) or >3 on ABCD (TIA)
  • Tx arm: 600 mg clopidogrel PO day 1, then 75 mg PO QD until day 90 +50-325 mg aspirin PO QD
  • Ctl arm: 162 mg aspirin PO QD x5, then 81 mg PO QD until day 90


Original Article from The New England Journal of Medicine — Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA

Source: Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA | NEJM