Combined antiplatelet prophylaxis fails to impact stroke severity
MedWire News: Adding clopidogrel to aspirin treatment in patients at high vascular risk has no effect on the severity of later stroke, say the CHARISMA investigators.
The primary finding of the CHARISMA (Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance) trial was that the addition of clopidogrel to aspirin therapy did not reduce the rate of stroke, myocardial infarction, or vascular death in high-risk patients, relative to aspirin alone.
"A secondary a priori hypothesis was that the addition of clopidogrel to aspirin may reduce the severity of stroke outcome events, perhaps by minimizing the size of thrombus formed on ruptured/eroded atherosclerotic plaque and thus the size of emboli to the brain and resultant brain infarction," the researchers write in the journal Stroke.
To assess this, Graeme Hankey (Royal Perth Hospital, Australia) and colleagues analyzed 436 patients, from the original 15,603 participants, who had suffered stroke during the 28-month study. Of these, 202 had been randomly assigned to receive clopidogrel and 234 were given placebo in addition to aspirin.
The average modified Rankin Scale (mRS) score at 3 months after stroke was 3.6 among patients assigned to clopidogrel and 3.3 among those given placebo, which was not a significant difference.
There were no differences in the proportion of patients achieving any specific score on the mRS, and no differences when the mRS was dichotomized at various points.
No differences in stroke severity were apparent when the team limited the analysis to the 233 patients whose qualifying event was stroke or transient ischemic attack. In this group, the average mRS scores at 3 months were 3.4 among patients assigned to clopidogrel and 3.3 among those given placebo.
"This trial fails to provide evidence that adding clopidogrel to aspirin significantly reduces the severity of stroke outcome events, as measured by the mRS, 3 months after stroke," conclude the researchers.
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By Eleanor McDermid