Clopidogrel-Aspirin Reduces New Strokes After Atherothrombotic Stroke

In the Phase III INSPIRES trial, clopidogrel-aspirin led to a lower risk of new stroke at 90 days than aspirin alone (7.3% vs. 9.2%, p = 0.008), in patients with mild ischemic stroke or high-risk transient ischemic attack of presumed atherosclerotic cause (n = 6100). The study, published in the New England Journal of Medicine, also demonstrated that moderate-to-severe bleeding associated with dual antiplatelet treatment is low, albeit higher than aspirin alone (0.9% vs 0.4%, p = 0.03).

The risk of recurrent stroke occurs early, with nearly half the 90-day stroke risk concurring withing the first 48 hours after an event. This risk is modifiable with interventions such as aspirin, dual antiplatelet therapies such as clopidogrel-aspirin or ticagrelor-aspiring if it is initiated within 24 hours.