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Comparison of antiplatelet regimens in secondary stroke prevention: a nationwide cohort study

Christine Benn Christiansen1,2, Jannik Pallisgaard3, Thomas Alexander Gerds4

  • 1Aalborg University Hospital, Forskningens Hus, Sdr. Skovvej 15, 9000, Aalborg, Denmark. christinebenn@hotmail.com.

BMC Neurology
|November 4, 2015
PubMed

Insights

For non-cardioembolic ischemic stroke, clopidogrel and aspirin-dipyridamole combination therapy showed similar low risks for recurrent stroke and bleeding. Aspirin alone presented higher risks for both outcomes.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Current guidelines recommend acetylsalicylic acid, clopidogrel, or aspirin-dipyridamole for preventing recurrent stroke in non-cardioembolic ischemic stroke patients.
  • The comparative risks of bleeding and recurrent stroke among these antiplatelet regimens require further investigation.

Purpose of the Study:

  • To compare the risks of recurrent ischemic stroke and bleeding associated with three common antiplatelet treatments: acetylsalicylic acid, clopidogrel, and the combination of acetylsalicylic acid and dipyridamole.

Main Methods:

  • A nationwide registry study identified patients discharged with first-time ischemic stroke between 2007-2010, excluding those with atrial fibrillation.
  • Hazard ratios and 1-year risks for recurrent ischemic stroke and bleeding were calculated for each treatment group.

Main Results:

  • Clopidogrel and aspirin-dipyridamole showed comparable risks for recurrent stroke (HRs: 1.02, 95% CI: 0.89-1.17) and bleeding (HRs: 1.06, 95% CI: 0.83-1.35).
  • Acetylsalicylic acid was associated with significantly higher risks for both recurrent stroke (HR vs. aspirin-dipyridamole: 1.48, 95% CI: 1.31-1.67) and bleeding (HR vs. aspirin-dipyridamole: 1.47, 95% CI: 1.18-1.82).
  • 1-year predicted risks for stroke were 11.1% for aspirin, 7.7% for aspirin-dipyridamole, and 8.0% for clopidogrel; bleeding risks were 3.4%, 2.4%, and 2.4%, respectively.

Conclusions:

  • Clopidogrel and aspirin-dipyridamole offer similar and favorable risk profiles for preventing recurrent ischemic stroke and associated bleeding.
  • Acetylsalicylic acid monotherapy appears to carry a higher risk of both recurrent stroke and bleeding, potentially due to selection bias.
Abstract

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