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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Springer Healthcare Limited. © Springer Healthcare Ltd;
2010
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