Short-term clopidogrel + aspirin prevents second ischemic stroke better than aspirin alone

Référence

Hao Q, Tampi M, O'Donnell M, Foroutan F, Siemieniuk RA, Guyatt G. Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack: systematic review and meta-analysis. BMJ 2018;363:k5108.

Sommaire

These authors searched several databases, including the Cochrane Central Register of Controlled Trials and reference lists of retrieved studies. They included studies that enrolled patients with a diagnosis of an acute minor ischemic stroke or high-risk transient ischemic attack for whom treatment was started within 3 days. Two researchers independently abstracted data from the studies and evaluated study quality. The identified 3 high-quality studies of 10,447 patients. When started within 24 hours of symptoms, combination treatment with clopidogrel and aspirin, as compared with either treatment alone, had no additional effect on reducing all-cause mortality but reduced the risk of nonfatal recurrent stroke by 1.9 percentage points (a reduction of 20 per 1000 patients treated). Stroke reduction benefit was most prominent in the first 10 days of treatment with the combination; there was little additional benefit after 21 days. The likelihood of major extracranial bleeding was slightly higher with the combination (0.2% absolute increase).