The POINT study (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke) compared treatment with aspirin alone (initially 600 mg daily, then 50 – 375 mg daily) vs aspirin with clopidogrel (75 mg daily) after minor stroke or TIA and was conducted in 10 countries spanning North America, Europe, Australia and New Zealand. Combination treatment was associated with lower risk of major ischemic events (5% vs 6.5%) but higher risk of major haemorrhage (0.9% vs 0.5%) than aspirin alone at a 90 day end-point. Importantly, patients could not participate if they were candidates for thrombolysis, endovascular therapy, or endarterectomy; had planned use of antiplatelet therapy or anticoagulation therapy (including those with presumed atrial fibrillation or cardiovascular disease, in whom anticoagulation would be indicated); had a contraindication to aspirin or clopidogrel; or had anticipated use of a NSAID for more than 7 days during the trial period. Major haemorrhage, was defined as symptomatic intracranial hemorrhage, intraocular bleeding causing vision loss, transfusion of 2 or more units of red cells or an equivalent amount of whole blood, hospitalization or prolongation of an existing hospitalization, or death due to hemorrhage. The study did not control for genetic polymorphism impacting upon the antiplatelet activity of clopidogrel, but subjects of Asian ethnicity accounted for < 3% of the study population. The use of PPIs or other acid-suppressive treatment was not reported . https://www.nejm.org/doi/full/10.1056/NEJMoa1800410?query=pfw&jwd=000020140177&jspc=PA&
Aspirin alone or dual anti-platelets after stroke?
May 18, 2018