A recent clinical trial examined the effectiveness of aspirin combined with other medicine to prevent recurring strokes in patients who had already suffered one that resolved quickly. Thirteen percent of those individuals will most likely suffer a larger stroke in the next five years, or a heart attack.   For about 6 percent of these patients, a stroke will occur within a year after a minor stroke.


The clinical trial showed adding the anti-platelet drug Plavix to a normal aspirin regimen reduced some serious risks but led to increased bleeding. A second study showed that another anticoagulant drug, Xarelto made no difference than the use of aspirin alone to reduce the onset of a stroke or heart attack after a small stroke.  This anticoagulant drug also increased the patient’s chance of bleeding.


Since the 1980s research has shown that aspirin works powerfully to help reduce secondary strokes in addition to its use as a blood thinner and pain reliever. Researchers have looked for new ways to use newer blood thinning medications that have become available over the years to help prevent strokes and have hoped they may perform better than aspirin. The use of blood thinners alone may help prevent blood clots but may also increase the risk of serious bleeding events that may require hospitalization or blood transfusions. The bleeding often occurs in the gastrointestinal tract but may also occur in the brain which may be disabling or deadly.


The first study conducted a large multinational clinical trial to examine the benefits and risks of using Plavix alongside aspirin to prevent further strokes.  The researchers found that 90 days after a minor stroke or TIA, using these two drugs reduced the risk of a serious heart attack or stroke from 6.5 percent to 5 percent.  The clinical trial was cancelled early when it found that during the same time period the patient’s chances of having a of major bleeding event doubled from 0.4 percent to 0.9 percent.


The second study found that the anticoagulant Xarelto was no more effective than aspirin alone in preventing the recurrence of a stroke in patients that already suffered a minor stroke.  The risk of a major hemorrhage was twice as high for those individuals who took both medicines than for those who only took aspirin.


SOURCE: latimes.com, “To prevent recurrent strokes, should aspirin have a wingman? Maybe not,” May 17, 2018, by Melissa Healy

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