6/29/23, 1:41 AM POINT Pathway Feedback Search Clinical Topics Home Studies POINT POINT Disease Disease Acute ischemic stroke Transient ischemic attack Trial question What is the effect of combination antiplatelet therapy with clopidogrel and aspirin in patients with minor ischemic stroke or high-risk TIA? Study design Multi-center Double blinded RCT Population Characteristics of study participants 45.0% female N = 4881 55.0% male 4881 patients (2195 female, 2686 male) Inclusion criteria: patients with minor ischemic stroke or high-risk TIA Key exclusion criteria: thrombolytic therapy within 1 week before the event, candidates for thrombolysis, endovascular therapy, or endoarterectomy, planned use of antiplatelet therapy or anticoagulation therapy, contraindication to aspirin or clopidogrel Interventions N=2432 dual antiplatelet therapy (clopidogrel at a loading dose of 600 mg on day 1, followed by 75 mg per day plus aspirin at a dose of 50-325 mg per day) N=2449 aspirin alone (at a dose of 50-325 mg per day plus matched placebo) https://web.pathway.md/studies/recjAkRav6pzZJBeA 1/2 6/29/23, 1:41 AM POINT Pathway Primary outcome Major ischemic events at 90 days 6.5 % 6.5 5 4.9 % 3.3 % Significant decrease 1.6 % NNT = 67 0.0 % Dual antiplatelet therapy Aspirin alone Significant decrease in major ischemic events at 90 days (5% vs. 6.5%; HR 0.75, 95% CI 0.59 to 0.95) Secondary outcomes Significant decrease in ischemic stroke (4.6% vs. 6.3%; HR 0.72, 95% CI 0.56 to 0.92) Significant decrease in total ischemic or hemorrhagic stroke (4.8% vs. 6.4%; HR 0.74, 95% CI 0.58 to 0.94) No significant difference in ischemic stroke, myocardial infarction, death from ischemic vascular causes, or major hemorrhage (5.8% vs. 6.8%; HR 0.84, 95% CI 0.67 to 1.05) Safety outcomes No significant differences in the rates of hemorrhagic stroke, symptomatic intracerebral hemorrhage, or other symptomatic intracranial hemorrhage and death from hemorrhagic vascular causes. Significant differences in major hemorrhage (0.9% vs. 0.4%, p = 0.02; HR 2.32, 95% CI 1.10-4.87) and minor hemorrhage (1.6% vs. 0.5%, p = 0.002; HR 3.12, 95% CI 1.67-5.83. Conclusion In patients with minor ischemic stroke or high-risk TIA, dual antiplatelet therapy was superior to aspirin alone with respect to major ischemic events at 90 days. Reference Johnston SC, Easton JD, Farrant M et al. Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. N Engl J Med. 2018 Jul 19;379(3):215-225. Open reference URL https://web.pathway.md/studies/recjAkRav6pzZJBeA 2/2