Authors
Diener H, Bogousslavsky J, Brass L, et al.
Title
Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial
References
Lancet 2004;364:331-337.
Background
Previous studies showed clopidogrel to be better than aspirin in patients with atherothrombotic disease (eg. CAPRIE)
Purpose
To determine whether the combination of clopidogrel and aspirin is better than clopidogrel alone for the prevention of recurrent ischemic vascular events in high-risk patients after TIA or stroke.
Design
  • Randomized, double-blind, placebo-controlled, parallel-group trial
  • 7, 599 patients with history of ischemic stroke or TIA in the previous 3 months and had one or more of five additional risk factors within the previous 3 years: previous ischemic stroke, myocardial infarction, angina, diabetes, or symptomatic peripheral arterial disease.
Exclusion Criteria
None.
Follow-Up
18 months
Treatment Regimen
  • Aspirin 75 mg once daily or matching placebo
  • Clopidogrel 75 mg once daily (in all patients)
Results
Primary Endpoint: Composite of ischemic stroke, MI, vascular death, or rehospitalization for an acute ischemic event (including unstable angina, TIA, worsening of peripheral arterial disease requiring intervention or urgent revascularization).

There was no significant difference in the primary or secondary endpoints.

Adding clopidogrel to aspirin resulted in significantly more bleeding than in the placebo and clopidogrel groups. No early increase was recorded in life-threatening bleeding (eg. Intracranial hemorrhage).
Summary
There is a non-significant difference in the reduction of major vascular events, with a significant increase in life-threatening or major bleeding with the addition of aspirin to clopidogrel in high risk patients with a history of ischemic stroke or TIA.
Implications
None.
Related Figures
[7]