26 Feb Stroke Prevention: No Advantage To Taking Three Blood Thinners After First Stroke

MedicalResearch.com Interview with:

Prof. Philip Bath

Professor Philip Bath
Stroke Association Professor of Stroke Medicine/Head of Division of Clinical Neuroscience
Faculty of Medicine & Health Sciences
University of Nottingham 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Blood thinning (antiplatelets) drugs reduce further strokes (recurrence) after stroke and mini-stroke (TIA). One antiplatelet, such as aspirin, is better than none, and two different drugs are better than one. The question then is whether three would be better still, providing excess bleeding is not problematic.

3096 patients with ischaemic stroke (stroke due to a blood clot) or mini-stroke were enrolled within 48 hours. They were randomised to take intensive separate antiplatelet therapy (three drugs comprising aspirin, clopidogrel and dipyridamole) or guideline therapy (either clopidogrel alone, or combined aspirin and dipyridamole) for 30 days (after which they took guideline treatment). At 90 days we assessed whether patients had had another stroke or mini-stroke, and how dependent or disabled this had left them.

There were slightly fewer recurrent strokes and mini-strokes between intensive and guideline treatment but the difference was not different statistically, so a neutral trial. In contrast, major bleeding was significantly increased in the intensive group as compared with guideline treatment. When looking at the net benefit/harm, there was no difference between the treatment groups.

MedicalResearch.com: What should readers take away from your report?

Response: Guideline antiplatelet treatment, as based on aspirin alone or combined aspirin and dipyridamole, is sufficient and there is no advantage in taking three different drugs.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Trials of combined super-strong antiplatelets and aspirin will need to closely watch major bleeding.

MedicalResearch.com: Is there anything else you would like to add?

Response: The trial was funded by the British Heart Foundation (UK charity) and National Institute of Health Research Health Technology programme (UK government). No pharmaceutical companies were involved. 

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Citation:

ISC 2017 abstract:

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Last Updated on February 26, 2017 by Marie Benz MD FAAD