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Adding Plavix to Aspirin Doesn't Help Guard Against Second Stroke: Study
Date:8/29/2012

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, Aug. 29 (HealthDay News) -- Adding the clot-busting drug Plavix to a daily dose of aspirin is no better than taking aspirin alone to prevent a second stroke in people who have had a type of stroke that is typically caused by chronic high blood pressure, a new study shows.

In fact, the combination increased the risk of gastrointestinal bleeding and death, the Canadian researchers report.

"Antiplatelet therapy is standard for the prevention of a second stroke," said study author Dr. Robert Hart, a professor of neurology at McMaster University in Hamilton, Ontario. "We wanted to see if combining two antiplatelet drugs, aspirin with clopidogrel [Plavix], would work better and prevent more strokes."

"We were disappointed that the combination of aspirin plus clopidogrel only showed a non-significant trend in reducing stroke," Hart said. "On the other side, the two together caused more bleeding and higher mortality. The higher mortality was completely unexpected."

"It is clear that the two drugs together should not be routinely used in people with lacunar stroke," he added.

Lacunar strokes occur in the small blood vessels in the brain and are most likely due to chronic high blood pressure; they account for roughly one-fifth of all strokes and are more common in blacks, Hispanics and people with diabetes.

Although lacunar strokes tend to be small, they can cause disability depending on where in the brain they occur.

The report was published in the Aug. 30 issue of the New England Journal of Medicine.

In the trial, researchers randomly assigned more than 3,000 patients who had suffered a lacunar stroke to a combination of aspirin and Plavix or aspirin and a placebo.

Patients were also randomly selected to receive aggressive blood pressure control or standard blood pressure control, the researchers noted.

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