Aspirin and Clopidogrel in Stroke/TIA

Henry I. Bussey, Pharm.D., FCCP, FAHA
August 2004

Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ; MATCH investigators. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004 Jul 24;364(9431):331-7.

Adding low dose aspirin (75mg daily) to clopidogrel in 3,759 high risk patients with a recent stroke or TIA failed to show any benefit when compared to 3,781 patients who received clopidogrel and placebo. Surprisingly, however, life-threatening bleeding was significantly increased with the addition of aspirin: 96 of 3,759 (3%) vs. 49 of 3,781 (1%), Similarly, major bleeding was increased 73 of 3,759 (2%) vs. 22 of 3,781 (1%). The higher rate of both categories of bleeding was statistically significant (p < 0.0001) in both cases. This combination has been shown to be beneficial in other indications and is being studied in stroke prevention. Approximately one-half of these patients had ischemia due to small vessel occlusion, one-third were due to large vessel atherosclerosis, and less than 5% were due to cardioembolic events. Other studies are evaluating this combination in primary prophylaxis of stroke and secondary prophylaxis of different types of stroke.