Secondary Stroke Prevention: An Adjunct to Avoid
Secondary Stroke Prevention: An Adjunct to Avoid
Dear colleagues, my name is Christoph Diener. I am a neurologist at the University of Essen in Germany. My topic today is secondary stroke prevention in patients with lacunar stroke.
Usually, we perform secondary stroke prevention with either aspirin monotherapy or the combination of aspirin and dipyridamole. In the MATCH trial, the combination of aspirin and clopidogrel was inferior to monotherapy with clopidogrel and had a higher rate of bleeding complications.
The trial I will talk about today is the SPS3 trial, which recruited patients with lacunar strokes on the basis of magnetic resonance imaging. The 3020 patients were randomly assigned to receive either 325 mg of aspirin monotherapy or a combination of aspirin plus clopidogrel. The primary endpoint was recurrent stroke. The study lasted for 3.5 years. On average, the mean age of the population was 63 years, and 63% of the patients were men.
The event rate, which is recurrent stroke, on dual-antiplatelet therapy was 125 strokes, which translates to 2.5% per year. For aspirin monotherapy, it was 138 strokes, which translates to a stroke rate of 2.7% per year. The hazard ratio was 0.92 and was not statistically significant. There was, however, a significant increase in major hemorrhages, with 105 hemorrhages in the dual antiplatelet therapy group and 56 hemorrhages in the aspirin monotherapy group. The hazard ratio was 1.97. There was also an increase in mortality, with 113 deaths in the combination antiplatelet therapy group and 77 deaths in the monotherapy group. The hazard ratio was 1.52, which was statistically significant.
The combination of aspirin and clopidogrel in patients with lacunar strokes is not superior to aspirin monotherapy and clearly carries a higher risk for stroke and death. This result is not a big surprise, because it is a replication of what has already been shown in the MATCH trial for aspirin and clopidogrel versus clopidogrel, as well as the CHARISMA trial, which looked at the combination of aspirin and clopidogrel versus aspirin in both primary and secondary stroke prevention. This means that for secondary stroke prevention, we should stay with either aspirin monotherapy or the combination of aspirin and dipyridamole.
Ladies and gentlemen, I am Christoph Diener, a stroke neurologist from the University of Essen in Germany. Thank you very much.
Dear colleagues, my name is Christoph Diener. I am a neurologist at the University of Essen in Germany. My topic today is secondary stroke prevention in patients with lacunar stroke.
Usually, we perform secondary stroke prevention with either aspirin monotherapy or the combination of aspirin and dipyridamole. In the MATCH trial, the combination of aspirin and clopidogrel was inferior to monotherapy with clopidogrel and had a higher rate of bleeding complications.
The trial I will talk about today is the SPS3 trial, which recruited patients with lacunar strokes on the basis of magnetic resonance imaging. The 3020 patients were randomly assigned to receive either 325 mg of aspirin monotherapy or a combination of aspirin plus clopidogrel. The primary endpoint was recurrent stroke. The study lasted for 3.5 years. On average, the mean age of the population was 63 years, and 63% of the patients were men.
The event rate, which is recurrent stroke, on dual-antiplatelet therapy was 125 strokes, which translates to 2.5% per year. For aspirin monotherapy, it was 138 strokes, which translates to a stroke rate of 2.7% per year. The hazard ratio was 0.92 and was not statistically significant. There was, however, a significant increase in major hemorrhages, with 105 hemorrhages in the dual antiplatelet therapy group and 56 hemorrhages in the aspirin monotherapy group. The hazard ratio was 1.97. There was also an increase in mortality, with 113 deaths in the combination antiplatelet therapy group and 77 deaths in the monotherapy group. The hazard ratio was 1.52, which was statistically significant.
The combination of aspirin and clopidogrel in patients with lacunar strokes is not superior to aspirin monotherapy and clearly carries a higher risk for stroke and death. This result is not a big surprise, because it is a replication of what has already been shown in the MATCH trial for aspirin and clopidogrel versus clopidogrel, as well as the CHARISMA trial, which looked at the combination of aspirin and clopidogrel versus aspirin in both primary and secondary stroke prevention. This means that for secondary stroke prevention, we should stay with either aspirin monotherapy or the combination of aspirin and dipyridamole.
Ladies and gentlemen, I am Christoph Diener, a stroke neurologist from the University of Essen in Germany. Thank you very much.