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Combination antiplatelet agents in ischemic cerebrovascular disease

Michael Moussouttas1, Nikolaos Papamitsakis

  • 1Cerebrovascular Division, Department of Neurology, Seton Hall University, South Orange, NJ, USA. arista1@pol.net

The Mount Sinai Journal of Medicine, New York
|February 1, 2005
PubMed

Insights

Combination antiplatelet therapies show mixed results for preventing cerebral ischemia. Aspirin plus extended-release dipyridamole may aid secondary prevention, but clopidogrel combination lacks proven benefits and increases bleeding risks.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Combination antiplatelet agents are increasingly used for vascular disorders.
  • Evidence for combination therapy efficacy in preventing cerebral ischemia is limited.
  • Recent trials offer preliminary data on combination antiplatelet effectiveness.

Purpose of the Study:

  • Review recent trials comparing combination antiplatelet regimens against aspirin alone.
  • Assess the effectiveness of combination therapies in preventing cerebral ischemic disease.
  • Discuss controversies and future directions for combination antiplatelet use.

Main Methods:

  • Systematic review of completed cerebrovascular and cardiovascular trials.
  • Comparison of combination antiplatelet regimens versus aspirin monotherapy.
  • Focus on cerebral ischemia as a primary outcome measure.

Main Results:

  • Clopidogrel plus aspirin did not prove superior to aspirin alone for primary prevention of cerebral ischemia.
  • Aspirin plus extended-release dipyridamole (xrDP) appears superior to aspirin alone for secondary prevention of cerebral ischemia.
  • Aspirin plus clopidogrel increases major hemorrhage risk; aspirin plus xrDP does not.

Conclusions:

  • Current evidence does not support clopidogrel plus aspirin for primary prevention of cerebral ischemia.
  • Aspirin plus xrDP may benefit secondary prevention but could impact cardiovascular protection.
  • Further research is needed to establish optimal combination antiplatelet strategies.

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