Clopidogrel Plus 21 Days of Aspirin Is Superior to Aspirin Alone Within First 24 Hours of TIA or Minor Stroke

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Am Fam Physician. 2014 Jan 1;89(1):55.

Clinical Question

Does adding clopidogrel (Plavix) improve outcomes over aspirin alone in the early treatment of transient ischemic attack (TIA) or minor stroke?

Bottom Line

Patients with minor stroke (National Institutes of Health [NIH] Stroke Scale score ≤ 3) or TIA have a decreased risk of recurrent stroke if given aspirin plus clopidogrel vs. aspirin alone if started within 24 hours of the onset of symptoms. There was no significant increase in the risk of bleeding events, and other cardiovascular outcomes were not affected. (Level of Evidence = 1b)


The researchers screened 41,561 patients with stroke or TIA at 114 clinical sites in China, and ultimately included 5,170 patients in the study. Inclusion criteria were as follows: 40 years or older, acute minor ischemic stroke or TIA, and an initial treatment given within 24 hours of symptom onset. Patients with low-risk TIAs (ABCD2 score < 3 points) were excluded. Patients with

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

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