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(Stroke. 2002;33:2546.)
© 2002 American Heart Association, Inc.

Letters to the Editor

Clopidogrel Plus Aspirin for Stroke Prevention

Mark J. Alberts, MD

Department of Neurology, Northwestern University Medical School, Chicago, Ill

J.Donald Easton, MD

Department of Clinical Neurosciences, Brown University School of Medicine, Providence, RI

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We are responding to the review by Drs Albers and Amarenco about the use of clopidogrel plus aspirin for patients with cerebrovascular disease.¹ We view the results of the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) study, added to all of the clopidogrel data, as more supportive of the combination of clopidogrel plus aspirin in stroke-threatened patients.

There is growing evidence to support the efficacy and safety of combination antiplatelet therapy for the prevention of vascular events. Combination therapies that inhibit platelet function by more than 1 mechanism may be more efficacious than single-agent approaches. The combination of clopidogrel with acetylsalicylic acid (ASA) has several beneficial features. Ex vivo studies have shown that clopidogrel plus ASA results in an 80% reduction in platelet aggregation using 20 µmol/L ADP as the stimulus based on light transmission aggregometry.² This is a substantially greater reduction than with either drug alone. Other studies have also documented the enhanced antithrombotic effects of clopidogrel plus ASA.^2,3 There is extensive experience with clopidogrel plus ASA in patients who receive coronary artery stents. A meta-analysis of coronary stenting in 13 955 patients found that the clopidogrel-plus-ASA combination compared with the ticlopidine-plus-ASA combination was associated with a 50% risk reduction in major adverse cardiac events and a 56% risk reduction in mortality (P=0.001 for both outcomes).⁴

The recently reported CURE study investigated the safety and efficacy of clopidogrel plus ASA in patients with acute coronary syndromes.⁵ This study of 12 562 randomized patients found that . . . [Full Text of this Article]

Gregory W. Albers, MD

Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California

Pierre Amarenco, MD

Bichat Hospital, Paris, France

This article has been cited by other articles:

				L. Chen, A. W. Bracey, R. Radovancevic, J. R. Cooper Jr, C. D. Collard, W. K. Vaughn, and N. A. Nussmeier Clopidogrel and bleeding in patients undergoing elective coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., September 1, 2004; 128(3): 425 - 431. [Abstract] [Full Text] [PDF]