Anti-thrombosis therapy 'no more effective' than second-line

The gold standard in anti-thrombosis therapy is no more effective than second-line treatment, according to findings from the largest study into secondary stroke prevention to date.

Current NICE guidelines, due to be reviewed shortly, suggest giving stroke patients dipyrimadole plus aspirin, or, if this proves unsuitable, clopidogrel.

But findings from the international Preventative Regimen for Effectively Avoiding Secondary Strokes (PRoFESS) trial, showed no significant differences between the two regimens regarding stroke prevention or incidence of MI or vascular death.

The study involved 20,332 patients with ischaemic stroke who were randomly assigned to each of the regimens for an average of 2.5 years.

Overall, 9 per cent of those given the dipyrimadole (200 mg) plus aspirin (25 mg) combination twice daily had a stroke, similar to the 8.8 per cent incident rate in the clopidogrel arm. Analysis showed that 7.7 per cent in the combination group and 7.9 per cent in the clopidogrel group had ischaemic stroke.

Analysis of secondary outcomes in the head-to-head study showed rates of MI and vascular death were also the same at 13.1 per cent, delegates were told at the European Stroke Conference in Nice, France, last week.

Although the benefit to risk ratio was said to be similar between the two groups, major haemorrhagic events and intracranial bleeds were noted in 4.1 per cent of those randomised to dipyrimadole plus aspirin, compared with 3.6 per cent of those given clopidogrel. Dropouts due to headache were also more common in the dipyrimadole plus aspirin arm, than with clopidogrel.

rachel.liddle@haymarket.com

European Stroke Conference - Nice, France

Blog - Covering a medical conference the French way

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