Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack: systematic review and meta-analysis

Review of 3 RCTs (n=10,447) found that compared with aspirin alone clopidogrel plus aspirin, started within 24 hours of symptom onset, reduced the risk of non-fatal recurrent stroke (RR 0.70, 95% CI 0.61-0.80, absolute risk reduction 1.9%)

There was no apparent impact on all cause mortality (RR=1.27, 95% CI=0.73 to 2.23) and a likely increase in moderate or severe extracranial bleeding (1.71, 0.92 to 3.20, absolute risk increase 0.2%).

A related article provides the data in an infographic, and summarises the evidence for practitioners.

NICE guidelines for Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (CG68) currently recommend aspirin 300mg daily in the acute setting.