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(Stroke. 1998;29:1737.)
© 1998 American Heart Association, Inc.

Letters to the Editor

Clopidogrel and Its Use in Stroke Patients

Philip B. Gorelick, MD, MPH

Center for Stroke Research, Chicago, Illinois

Daniel F. Hanley, Jr, MD

Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland

To the Editor:

Substantial clinical data support the use of antiplatelet therapy in reducing the incidence of secondary atherothrombotic events in individuals who have experienced a transient ischemic attack (TIA) or stroke.¹ The consensus based on recent trials is that antiplatelet therapy can reduce the incidence of subsequent ischemic events in those patients for whom carotid endarterectomy is not indicated and for whom atrial fibrillation is not a contributing factor.² Aspirin has been the antiplatelet drug most frequently evaluated, and numerous trials support its efficacy. Ticlopidine, a thienopyridine antiplatelet agent, is also effective in preventing recurrent ischemic events in the stroke patient,³ but the risk of bone marrow depression and questions about its superiority to aspirin in reducing ischemic vascular events other than subsequent stroke have been raised.^{4 5 6} Recently clopidogrel, an analog of ticlopidine that has not demonstrated bone marrow toxicity, was approved by the Food and Drug Administration for use in patients at risk of recurrent ischemic events, including stroke, myocardial infarction, and limb claudication. The clinical data supporting the use of clopidogrel, however, may provide no compelling justification for using clopidogrel in preference to aspirin in stroke patients.

Although the CAPRIE (Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events) trial⁷ found a statistically significant reduction in the combined incidence of stroke, myocardial infarction, and vascular death for clopidogrel compared to aspirin, the magnitude of the therapeutic advantage was small (an 8.7% relative risk reduction, or a decrease in the absolute event rate from 5.83%/y to 5.32%/y . . . [Full Text of this Article]

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