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Clopidogrel plus asprin cuts risk of stroke by 28%

By Nigel Praities

Combined therapy with clopidogrel and aspirin can substantially reduce the risk of stroke in patients not suitable for warfarin therapy, say researchers.

Their randomised trial in over 7,500 patients with atrial fibrillation and at least one risk factor for stroke, found patients receiving clopidogrel and aspirin had a 11% decrease in major vascular events, compared with those just taking aspirin.

The reduction was mainly due to a 28% risk reduction in stroke in this population of patients who, for various reasons, were unsuitable for warfarin therapy.

In 2005, a head to head study dashed hopes that the clopidogrel-aspirin combination could replace warfarin, after it was stopped prematurely because of a significant difference in preventing vascular events was observed in favour of warfarin.

This new study – published online in The New England Journal of Medicine - suggests clopidogrel should be added to aspirin therapy in the 40% of patients who are not suitable for warfarin therapy – such as those with a bleeding risk or those likely not to be compliant with therapy.

Professor John Camm, professor of clinical cardiology at St George's Hospital Medical School, London, said the study showed this difficult group of patients could have better thrombotic control with clopidogrel than they could get from aspirin alone.

‘The management of warfarin is very difficult and there are often concerns about patient compliance or the interactions and complications of taking warfarin.

‘If patients can be managed successfully on warfarin, then we would like them to stay on warfarin. But if they are not on it, or are having some difficulties, then the combination of clopidogrel and aspirin could provide some advantage,' he said.

Professor Camm said there were concerns over an increased risk of bleeding with the combination, but these were trivial compared with the thrombo-embolic risk in these patients. ‘The net benefit is pretty high,' he said.

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