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(Stroke. 2005;36:707.)
© 2005 American Heart Association, Inc.

Letters to the Editor

Emerging Therapies: Clopidogrel and Aspirin

Michael Moussouttas, MD

NJ Neuroscience Institute at JFK Medical Center, Seton Hall University, Edison, NJ

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

To the Editor:

We read with interest the commentaries regarding the recently published Management of Atherothrombosis with Clopidogrel in High-Risk Patients (MATCH) trial¹ and wish to contribute some additional perspectives. Patient baseline characteristics have been cited as reasons for the neutral results and detrimental outcomes observed.¹

The large number of patients with small-vessel qualifying events is one reason cited for treatment failure, and Dr Caplan notes that there were "too few patients with documented large-artery disease in MATCH." On the contrary, the prevalence of lacunar infarctions among participants in MATCH was similar to or less than that of other recent large randomized cerebrovascular trials (53% versus 56% to 67%),^2–4 whereas the proportion of patients with large-vessel infarctions was greater (34% versus 12% to 20%).^2–4 Additionally, as Dr Caplan himself states, some patients with large-artery disease may have been misdiagnosed as "lacunar" if adequate intracranial artery studies were not performed. Given the preponderance of diabetes in the MATCH study population, intracranial atherosclerosis may well have been underestimated, and thus the total percentage of large-vessel qualifying infarctions may have exceeded the reported 34%.² Notably, outcome analyses were negative for lacunar and large-vessel subgroups.²

The frequency of hypertension was also greater than that of most previous studies (78% versus 51% to 68%)^2,3,5,6 but less than that of a recent trial evaluating ticlopidine against aspirin in black patients (86%).⁴ In contrast to MATCH, no increase in intracranial hemorrhages was observed in the ticlopidine study.⁴ There was also no increase in intracranial hemorrhages in the . . . [Full Text of this Article]