Are aspirin and clopidogrel used together for stroke prevention

Are aspirin and clopidogrel used together for stroke prevention? 

Aspirin should not be combined with clopidogrel for long-term secondary stroke prevention due to unacceptably high bleeding risk without additional protection from strokes (SPS3 [Secondary Prevention of Small Subcortical Strokes] and MATCH (Management of Atherothrombosis with Clopidogrel in High-risk patients) trials).

The CHANCE (Clopidogrel in High-risk patients with Acute Nondisabling Cerebrovascular Events) trial found that aspirin plus clopidogrel for the 21 days after stroke reduced the odds of a second stroke within 90 days.

Most participants were from China where blood pressure control is less frequently achieved. In the absence of definitive data, either short-term dual antiplatelets or a single antiplatelet agent may be used for secondary stroke prevention.

Patients on dual antiplatelets for other indications may be continued on this combination after stroke with the understanding that bleeding risk may be elevated.

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