Lower aspirin doses combined with clopidogrel may reduce ischemic events in high risk patientsLower Aspirin Doses May Be Safer for Patients After Minor Strokes

BACKGROUND: A short-term course of aspirin and clopidogrel has become standard practice in patients with high-risk transient ischemic attacks (TIA)s and minor ischemic stroke, although the appropriate dose of aspirin in such patients is not known. OBJECTIVE: To compare the safety and stroke risk reduction in patients treated with ≤100 mg with those treated with >100 mg per day of aspirin in patients receiving both aspirin and clopidogrel. METHODS: We analyzed data from the patients treated with aspirin and clopidogrel for 90 days in the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial. Patients were treated with aspirin at a dose of 50 to 325 mg per day (as decided by the site investigator) and were dichotomized into patients treated with ≤100 mg and those treated with >100 mg per day for the analysis. We analyzed the effect of aspirin dose on the occurrence of primary composite outcome (composite of ischemic stroke, myocardial infarction [MI], or death from an ischemic vascular event) and incident ischemic stroke within 90 days using Cox Proportional Hazards analyses. RESULTS: Aspirin was used as ≤100 mg and >100 mg daily in 1721 and 559 patients, respectively, in addition to 75 mg daily of clopidogrel. Patients who were treated with aspirin >100 mg per day had a higher proportion of patients with hypertension, congestive heart failure, and pre-event use of aspirin. A total of 73 in 1721 and 37 in 559 patients developed the composite endpoint (p = 0.03). In Cox proportional hazards analysis, the risk of primary composite outcome occurrence was significantly higher in patients treated with aspirin >100 mg per day (hazards ratio 1.62, 95% confidence interval 1.08 -2.42) after adjusting for race, hypertension, congestive heart failure, and pre-event use of aspirin. The risk of ischemic stroke occurrence was significantly higher in patients treated with aspirin >100 mg per day (hazards ratio 1.72, 95% confidence interval 1.13-2.60) after adjusting for the above-mentioned confounders. There was no difference in the proportion of patients who developed symptomatic intracranial hemorrhage between the two groups (0.7% versus 0.5%, p = 0.914) CONCLUSIONS: In the POINT study, a lower dose of aspirin showed greater reduction in ischemic stroke, MI, or death when used in combination with clopidogrel in patients with high-risk TIAs or minor ischemic stroke.