A recent study has confirmed that patients who have suffered a previous stroke due to chronic high blood pressure do not gain a protective benefit from adding Plavix (clopidogrel) to their daily dose of aspirin.
The study, which is published in the August 30th issue of the New England Journal of Medicine, examined patients who had previously suffered a lucunar stroke. A lacunar stroke occurs in the small blood vessels in the brain and is most often caused by chronic high blood pressure. Lacunar strokes account for approximately 20% of strokes in the general population, but are more prevalent among African American, Hispanic and diabetic individuals. Researchers randomly administered to in excess of 3,000 lacunar patients a combination of either aspirin and Plavix or aspirin and a placebo.
As the study’s author Dr. Robert Hart of McMaster University in Ontario explained, the study was commissioned to determine “if combining two antiplatelet drugs, aspirin with clopidogrel, would work better and prevent more strokes.” However, Dr. Hart was ultimately “disappointed that the combination of aspirin plus clopidogrel only showed a non-significant trend in reducing stroke.” Moreover, and of notable concern, Plavix and aspirin “together caused more bleeding and higher mortality. The higher mortality was completely unexpected.”
Ultimately Dr. Hart concluded that it “is clear that the two drugs together should not be routinely used in people with lacunar stroke.” These sentiments were echoed in principle by the director of interventional cardiovascular research at Lenox Hill Hospital, commenting that the “lesson here is we shouldn’t start writing prescriptions for Plavix to those patients with lacunar strokes. Practitioners have to pay attention to these negative trials.”