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Evidence for clopidogrel in prevention of stroke

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

With respect to the use of the clopidogel following an ischaemic stroke, NICE have suggested that (1):

  • clopidogrel is indicated as first line long-term antiplatelet treatment following an ischaemic stroke

Evidence from the Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE) trial showed (2):

  • after about two years, the risk of reaching the combined primary endpoint of ischaemic stroke, MI or vascular death was slightly lower with clopidogrel than aspirin (5.32% vs. 5.83%) - thus nearly 200 people would have to be treated with clopidogrel instead of aspirin to prevent one event
  • on subgroup analysis, a statistically significant difference was only found in patients with peripheral arterial disease and not those who hand previously had a stroke (3) - however the trial was not powered to assess this (2)

Comparison of clopidogrel versus aspirin plus dipyridamole:

  • the ProFESS trial compared the efficacy of 25 mg aspirin (ASA) and 200 mg extended-release dipyridamole (ER-DP) twice a day versus 75 mg clopidogrel once a day in patients with ischaemic stroke, both regimes resulted in similar rates of recurrent stroke (4)

Reference:

  1. NICE (December 2010).Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
  2. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996 Nov 16;348(9038):1329-39.
  3. MeReC Bulletin (2003), 14 (2), 5-8
  4. Diener HC et al. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo-controlled study. Lancet Neurol. 2008 Oct;7(10):875-84.

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