Aspirin-clopidogrel no better than aspirin alone for patients with lacunar stroke
Aspirin combined with the antiplatelet drug clopidogrel is no better than aspirin alone for stroke prevention in people with a history of lacunar strokes.
Balintfy: Lacunar strokes are small strokes that usually occur in the very deep parts of the brain. Dr. Walter Koroshetz at the NIH explains, they’re due to the blockage of very tiny blood vessels that are so small, they can only be seen under the microscope.
Koroshetz: Lacunar strokes — these what we call white matter, small vessel disease strokes – are extremely common and they are related primarily to hypertension. So in some instances, it’s thought that maybe 40% of people will have a silent small stroke at some time in their life and most of these are these small vessel strokes.
Balintfy: He adds that these small blood vessels are unique in other ways as well.
Koroshetz: They dive into the deep parts of the brain and they're affected by hypertension much more than any other blood vessels in the body.
Balintfy: A recent study has enrolled more than 3,000 patients with small vessel stroke to test two interventions.
Koroshetz: One was aggressive blood pressure lowering, as I mentioned blood pressure is the key risk factor for these strokes, and the other one was comparing a combination of two antiplatelet agents to aspirin alone.
Balintfy: Aspirin itself is an antiplatelet agent – a drug that stops blood from forming harmful clots. Strokes occur when blood vessels that supply the brain rupture or become blocked, such as by a blood clot. Dr. Koroshetz says study results recently published in the New England Journal of Medicine show that the combination of two antiplatelet agents was no better than aspirin alone.
Koroshetz: We were hoping that we’d have a more potent therapy, but it turns out that the simple aspirin is really the best thing.
Balintfy: He adds that study continues to examine antiplatelet combination therapies for patients with other types of stroke.
Koroshetz: In heart disease, particularly in patients who have had stents or heart attacks, the combination has been shown to be superior to aspirin alone and that was the kind of the basis for the trial going forward. But in this and some other stroke trials, it has also been demonstrated the combination is not more helpful than a single antiplatelet agent.
Balintfy: In fact, the study found that combining aspirin and the drug clopidogrel was about equal to aspirin in reducing the risk of any type of stroke, but it almost doubled the risk of gastrointestinal bleeding. Dr. Koroshetz points out that the other part of the study is comparing blood pressure control.
Koroshetz: The study is ongoing, testing whether the real aggressive blood pressure lowering is superior to standard blood pressure control and we await the final results of that study.
Balintfy: Other recent studies have shown that recurrent stroke rates for people in all blood pressure control groups have dropped. For more information on this study, and to learn more about strokes and stroke risk, visit the website stroke.nih.gov. And to hear more from Dr. Koroshetz on this topic, tune into episode 169 of the NIH Research Radio podcast. For NIH Radio, this is Joe Balintfy — NIH...Turning Discovery Into Health®
About This Audio Report
Reporter: Joe Balintfy
Sound Bite: Dr. Walter Koroshetz
Topic: stroke, strokes, lacunar stroke, stroke prevention, antiplatelet, aspirin, clopidogrel, blood vessel, brain, hypertension