In a major study (PRoFESS) completed in 2008, two anti-platelet drugs (Aggrenox and Plavix) were compared to each other. The implications of this trial are still filtering through the neurological community.
The trial involved, in part, placing patients who had suffering from an ischemic stroke on either Aggrenox (aspirin + extended release dipyrimadole) or Plavix (clopidogrel) within 90 days of their stroke. Patient who had strokes due to heart disease (cardioembolic strokes) were not included in the study. Patients were then monitored long-term for both side effects and new ischemic strokes.
The results? There was no significant difference in primary outcome (number of new ischemic strokes) between Aggrenox (9%) and Plavix (8.8%). There was, though, a slightly higher tendency for serious bleeding (major hemorrhagic events) in the Aggrenox group (4.1%) compared to Plavix (3.6%).
How has this result affected my prescribing?
This result has greatly affected my prescribing. Based on a previous trial (ESPS-2) I had formerly been in favor of Aggrenox as the clear favorite (over Plavix and aspirin) for secondary stroke prevention (stroke prevention after an initial ischemic stroke or transient ischemic attack). Now I would actually favor Plavix. The reasons are as follows:
(1) Plavix appeared to do as well or slightly better at preventing strokes (compared to Aggrenox)
(2) Plavix had fewer significant bleeding events
(3) Plavix is easier to take for patients (once a day versus twice a day).
(4) Patients who start Aggrenox often experience headaches.
(5) Cardiologists tend to favor Plavix for coronary artery disease (CAD) - so patients who have both ischemic stroke and CAD can be appropriately treated with Plavix.