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Lacunar Stroke - Dual Therapy Not Helpful

Photo of Armand Leone

Treatment of recent lacunar stroke with aspirin alone compared with aspirin and Plavix shows that aspirin is as effective as using both together. More importantly, aspirin alone caused fewer major hemorrhages and death. A recent study in the New England Journal of Medicine investigate treatment of patients who suffered acute lacunar strokes. These brain infarcts result from occlusion of one of the arteries that penetrate into the deep brain structures and can result in typical symptoms as well as ataxia (incoordinated muscular movements), dysarthria (difficulty saying words) and clumsiness of the hand especially when writing.

The study looked at 3020 patients with recent lacunar stroke who were randomly assigned to treatment with aspirin 325 mg daily with Plavix and aspirin alone. The study looked primarily at the number of patients that had recurrence over 3.4 years. The results showed that 2.5% of patients on both drugs and 2.7% of patients on aspirin alone had another episode. However, the risk of major hemorrhage was almost double with both clopidogrel and aspirin, increasing from a rate of 1.1% to 2.1% of patients. This is the first study to show that, although dual platelet therapy reduces infarcts caused by atherosclerosis, aspirin alone is superior to dual platelet therapy when treating lacunar infarcts - it is as effective and causes fewer hemorrhagic side effects.

Rapid recognition, diagnosis and treatment is important to save brain function. Failure to diagnose stroke occurs when patients are not treated promptly and correctly which causes them to have decreased chances of recovery. Equally important is that the correct therapy, aspirin alone or dual platelet therapy with aspirin and clopidogrel, be used. While dual platelet therapy is appropriate treatment for atherosclerotic disease, aspirin alone is superior for treatment of lacunar stroke.

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