Does clopidogrel prevent stroke recurrence?
Two randomized trials have tested the effectiveness of clopidogrel to prevent secondary stroke in a group of patients with a prior stroke or TIA. The Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial compared clopidogrel with aspirin in patients with a stroke, a recent MI, or established peripheral vascular disease. For patients with a history of stroke or TIA, clopidogrel was not superior to aspirin for prevention of a subsequent stroke, MI, or death due to another vascular cause. The most recent ACCP guideline, citing both an unclear risk-benefit ratio and concerns about study methodology and results, makes a weak recommendation (Grade 2B) favoring clopidogrel over aspirin for prevention following a noncardioembolic stroke or TIA. Clopidogrel should be considered first-line therapy to prevent recurrent stroke only in patients with aspirin allergy or sensitivity. • When should warfarin be considered for stroke patients? Warfarin is not recommended as an
