Combination 'increases major bleeding risk'

European Stroke Conference - Bleed risk with clopidogrel and aspirin - Dronedarone cuts stroke risk in AF.

Patients who take aspirin in combination with clopidogrel following a TIA could be at an increased risk of suffering major bleeding, a UK study has found.

The findings appear to conflict with research presented last month at the American College of Cardiology Conference which suggested that aspirin and clopidogrel could be a safer alternative for patients who are unable to tolerate warfarin.

The Active-A study showed that a combination of aspirin and clopidogrel reduced the risk of stroke by 28 per cent among AF patients without producing any major bleeding.

This latest study, presented last week at the European Stroke Conference in Stockholm, compared the risk of bleeding among 827 patients who were treated with either aspirin and clopidogrel or just aspirin.

A total of 3.2 per cent of patients who were taking the combination of drugs suffered bleeding within 90 days of starting treatment compared with just 1 per cent of patients in the aspirin-only arm.

Patients who were aspirin-naive before the study and who were on the combination treatment were found to be most at risk of bleeding.

The use of PPIs in addition to aspirin and clopidogrel was not found to offer any protection against the risk of bleeding.

The researchers, from the stroke prevention unit at the University of Oxford, concluded that 'a short day course of aspirin and clopidogrel in acute TIA or minor stroke was associated with a high risk of major bleeding in aspirin-naive patients'.

The researchers added that further randomised trials of short-term aspirin and clopidogrel versus aspirin alone are needed to determine the balance of risk and benefits to patients after an acute TIA and minor stroke.

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