DAPT vs Aspirin Alone: Which is Best Post-Stroke?

Although dual antiplatelet therapy (DAPT) with clopidrogel and aspirin can lower the risk of major ischemic events in patients with minor ischemic stroke or transient ischemic attack (TIA), it is associated with a higher risk of major hemorrhage compared with aspirin alone, according to new findings.

In a randomized trial, researchers assessed 4881 patients with minor ischemic stroke or TIA who were enrolled at 269 international sites.

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Each patient was randomly assigned to treatment with either clopidogrel at a loading dose of 600 mg on day 1, followed by 75 mg per day, plus 50 mg to 325 mg aspirin per day, or the same range of doses of aspirin alone.

The primary efficacy outcome was defined as the 90-day risk of a composite of major ischemic events—including ischemic stroke, myocardial infarction, or death due to an ischemic vascular event.

Ultimately, the trial was halted after the data and safety monitoring board found that DAPT with clopidrogel and aspirin was associated with a decreased risk of major ischemic events, but an increased risk of major hemorrhage compared with aspirin alone at 90 days.

A total of 121 (5.0%) patients treated with DAPT and 160 (6.5%) patients who received aspirin plus placebo experienced major ischemic events (hazard ratio 0.75). The researchers noted that most events occurred within the first week after the initial event.

Twenty-three (0.9%) patients receiving DAPT and 10 patients (0.4%) receiving aspirin plus placebo experienced major hemorrhage (HR 2.32).

Findings from the trial were presented at the European Stroke Organization Conference in Gothenburg, Sweden.

—Christina Vogt

Reference:

Claiborne Johnston S, Easton JD, Farrant M, et al; Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network, and the POINT Investigators. Clopidrogel and aspirin in acute ischemic stroke and high-risk TIA [Published online May 16, 2018]. N Eng J Med. doi:10.1056/NEJMoa1800410