My friend Donald recently suffered a transient ischemic attack (TIA), also known as a ministroke or warning stroke. His strokelike symptoms lasted only a few minutes, and he emerged without permanent damage. But he’s not home-free—because 10% to 20% of TIA patients go on to have a full-blown stroke within 90 days.
Breakthrough: Now there’s a way to reduce that risk by one-third. It involves adding a second type of pill to the standard pill that TIA patients take. But to work best, the dual treatment should begin right away after a TIA. That’s why I want you to know about it—so you’ll be prepared in case you or a loved one ever suffers a TIA.
DYNAMIC DRUG DUO
The vast majority of strokes are ischemic strokes, the type caused by a blood clot. That’s why it’s standard for TIA patients to start taking a daily aspirin, because aspirin is known to help prevent clots. Aspirin’s benefits in this regard, though, are rather modest. So researchers set out to determine whether adding the anticoagulant drug clopidogrel (Plavix) would help. Like aspirin, clopidogrel works by preventing platelets (a type of blood cell) from collecting and forming clots. Clopidogrel is not risk-free—it can cause significant bleeding—but researchers wanted to see whether its benefits outweighed its risks for TIA patients.
The new study included 5,170 people who had had a TIA or a similar kind of ministroke called an acute minor ischemic stroke within the previous 24 hours. All patients received aspirin right away. The first dose ranged from 75 milligrams (mg) to 300 mg, depending on their doctors’ decisions, then the dose was dropped to 75 mg from day two onward.
Patients were randomly divided into two groups. In one group, patients received daily aspirin plus a placebo through day 90. In the other group, patients received clopidogrel at a dose of 300 mg on day one and 75 mg on days two through 90, plus daily aspirin for 21 days. In this dual-therapy group, aspirin was discontinued after 21 days to minimize the risk for bleeding.
Here’s what happened over the course of the 90 days…
- Stroke occurred in 12% of patients in the aspirin-only group, but in only 8% of the patients in the clopidogrel-plus-aspirin group—meaning that the likelihood of suffering a stroke was one-third lower in the clopidogrel-plus-aspirin group.
- Fatal or disabling stroke occurred in 7% of aspirin-only users…but in only 5% of clopidogrel-plus-aspirin users.
- Hemorrhagic stroke (the type caused by bleeding rather than a clot) occurred at an identical rate of 0.3% in both groups…and other severe bleeding events (such as bleeding that required surgery or transfusion) occurred at an identical rate of 0.2% in both groups. This was important—because it meant that adding the 90-day clopidogrel therapy to the 21-day aspirin therapy did not increase patients’ risk for hemorrhagic stroke or other severe bleeding problems. The rate of mild bleeding events (such as bruising or oozing from puncture sites) was slightly higher among the clopidogrel-plus-aspirin users.
TIMING MATTERS BIG TIME
Because this study was conducted in China, some experts would like to see the results confirmed before the two-pill therapy becomes the standard of care in the US. It’s also worth noting that, because the study follow-up period lasted 90 days, it’s not known whether any participants went on to have strokes later—but remember, the riskiest period for stroke occurs right after a TIA. That’s why the researchers said that starting treatment with clopidogrel-plus-aspirin as soon as possible after TIA symptoms appear is likely to produce the greatest benefit. Note that doctors generally recommend that TIA patients stay on antiplatelet therapy indefinitely.
What to watch for: The most typical warning signs of a TIA are exactly the same as those of a stroke—sudden numbness or weakness of the face, arm or leg, especially on one side of the body…sudden confusion or trouble speaking or understanding speech…sudden loss of balance or coordination or difficulty with walking…sudden problems with vision in one or both eyes…and/or a sudden, severe headache with no known cause.
As soon as symptoms appear: Seek emergency medical help without delay! If it turns out that you are having a TIA, ask your doctor whether the dual clopidogrel-plus-aspirin therapy is right for you. Remember, the sooner you get started on the treatment, the better your chances of avoiding a full-blown stroke.