AsianScientist (Jul. 1, 2013) – Scientists report that a simple two-drug combination reduces the risk of subsequent strokes in patients in China with minor or transient stroke symptoms.
Plavix, the marketed combination of two anti-clotting drugs: clopidogrel and aspirin, was found to be more effective than aspirin alone, according to a clinical trial conducted at the Beijing Tiantan Hospital in China.
Stroke is a leading cause of death and disability worldwide. The current standard medical intervention after stroke incidences uses aspirin, an anti-platelet drug that prevents clotting agents, such as platelets, from aggregating in the bloodstream.
In comparison with the United States, China reports higher stroke rates with three million new stroke cases every year of which about 30 percent are classified as minor strokes. Minor strokes are a result of blood clots in blood vessels that oxygenates the brain. They are typically short in an episode, and do not result in persistent health conditions thereafter. These clots ease quickly, usually in minutes, due to the human body’s natural mechanism to cope with such clots.
Despite the body’s natural ability to resolve the initial blood clots, there is still an increased risk that additional clots could lead to a potentially full-blown stroke within three months, with 10-20 percent of patients with minor strokes or transient ischemic attacks (TIAs) experiencing subsequent strokes in the following three months.
Currently, minor strokes or TIA patients are treated with the standard aspirin monotherapy. Clopidogrel, another anti-platelet drug, is commonly used together with aspirin only in patients who had heart attacks. This combinatorial drug regimen however, was not supported with adequate clinical data to be used as medical interventions in stroke patients.
The objective of the Phase III clinical trial, called CHANCE (Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events), was to determine if Plavix was more effective than aspirin alone in the intervention of subsequent stroke attacks in patients who suffered minor ischemic strokes or TIAs. The trial included 5,170 patients across multiple clinical sites in China, who were randomized into two groups and treated with either the standard aspirin monotherapy or with Plavix for three months.
Results of the CHANCE trial, published in the New England Journal of Medicine, showed that patients on the combinatorial drug regimen had their risk of subsequent strokes reduced by almost one-third. In the follow-up of three months, 11.7 percent of patients on aspirin alone suffered subsequent strokes compared to 8.2 percent of patients on Plavix.
Moving forward, there is a nearly identical study called POINT (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke) in the United States, led by S. Claiborne Johnston, MD, PhD, a professor of neurology and associate vice chancellor of research at UCSF, who was a senior author on the CHANCE study.
“If POINT confirms CHANCE, then we’re done – the two-drug combination becomes the standard of care,” said Johnston. “Anybody with a transient ischemic attack or minor stroke will get clopidogrel plus aspirin.”
The article can be found at: Wang Y et al. (2013) Clopidogrel with Aspirin in Acute Minor Stroke and Transient Ischemic Attack.
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Source: UCSF; Photo: Liz Henry/Flickr/CC.
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