Following a stroke, treatment with the anti-clotting drug clopidogrel can help prevent future strokes and heart attack. Recent research shows that clopidogrel doesn't work any better when given with the blood-thinner aspirin and, in fact, the risk of bleeding complications is increased. Researchers from the Johannes Gutenberg University, Germany, studied 7599 high-risk patients who were treated with clopidogrel plus either aspirin or and inactive placebo for 18 months. An interesting finding was the percentage of patients who experienced another stroke, a heart attack, a death related to these causes or re-hospitalisation for blood flow problems. The researchers found that about 16 percent of patients in each group had this outcome, suggesting that two drugs were no more effective than one. Serious bleeding complications were rare - the rate did not exceed 3 percent in either group. However, it was found that patients treated with clopidogrel plus aspirin were 26 to 36 percent more likely to experience such complications than their peers in the clopidogrel -only group. The rate of fatal bleeding was comparable and less than 1 percent for both groups. The researchers concluded that further analysis of the current data could tell whether early bruising or bleeding would predict subsequent major bleeding and whether a short period of treatment with aspirin and clopidogrel in the acute phase might be effective.
The Lancet,
June 2004