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Is Intensive Antiplatelet Therapy Safe for Stroke Patients?

Intensive antiplatelet therapy does not reduce the incidence or severity of recurrent stroke or transient ischemic attack (TIA) in patients with recent cerebral ischemia, and significantly increases the risk of major bleeding, according to the results of a recent study.
Antiplatelet therapy with 3 agents has been suggested to potentially be more effective than recommended treatment for the prevention of recurrent ischemic events in patients with acute cerebral ischemia.
In a recent international, prospective, randomized, open-label, blinded-endpoint trial, researchers aimed to compare the safety and efficacy of antiplatelet therapy with aspirin, clopidogrel, and dipyridamole (intensive) with guideline-based antiplatelet therapy. The trial involved 3096 participants, randomly assigned 1:1 to receive either guideline-based therapy (clopidogrel alone or combined aspirin and dipyridamole) or intensive therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily).
Overall, the incidence and severity of recurrent stroke or TIA was not different between the intensive and guideline-based treatment groups (6% vs 7%, respectively). However, intensive therapy was associated with more frequent and severe bleeding than guideline-based treatment. In response to these findings, the trial was stopped early on the recommendation of the data monitoring committee.
“Among patients with recent cerebral ischemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding,” the researchers concluded. “Triple antiplatelet therapy should not be used in routine clinical practice.”

REFERENCE:
Bath PM, Woodhouse LJ, Appleton JP, et al. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial [published online December 20, 2017]. Lancet. http://dx.doi.org/10.1016/S0140-6736(17)32849-0