In a symposium at the Philippine Neurological Association’s 10th mid-year convention held on Panglao Island in Bohol, Dr. Lawrence Wong discussed the trial results which he considers a breakthrough in the management of cerebrovascular diseases.
His presentation was entitled "Risk Stratification for Secondary Stroke Prevention."
Wong is chief of neurology at the Prince of Wales Hospital in Hong Kong. He is the immediate past president of the Hong Kong Neurological Society and the Asian Chapter of the Research Group of Neurosonology of the World Federation of Neurology.
The MATCH (Management of ATherothrombosis with Clopidogrel in High Risk Patients with recent transient ischemic attack or ischemic stroke) trial enrolled 7,599 patients across 507 centers in 28 countries.
The study compared aspirin to placebo on top of the clopidogrel background therapy in the prevention of further ischemic events.
Results show that aspirin, when added to clopidogrel and other standard prevention therapies in high-risk cerebrovascular patients, does not result in an improved benefit-to-risk ratio compared to placebo, according to Wong.
He stressed that the addition of aspirin did not give additional benefit when combined with clopidogrel.
Neurologists who attended the symposium hailed the results of the study. Dr. Joven Cuanang, president of the Stroke Society of the Philippines, said, "With these new studies, we’re now more sure of what to do."
He added, "Clopidogrel is superior to aspirin. It should be used to reduce the risk of another attack."
Dr. Abdias Aquino, first vice president of the Stroke Society of the Philippines, said, "I’ve seen a lot of intolerance with aspirin; the hemorrhagic side-effects are horrifying."
Results of the MATCH trial were announced last May at the 13th European Stroke Conference held in Mannheim-Heidelberg, Germany.
"The MATCH trial shows that in high-risk population of cerebrovascular patients with several additional risk factors, adding aspirin to clopidogrel background therapy shows a non-significant trend versus adding placebo in reducing further ischemic events but leads to more life-threatening bleedings," said Prof. Dr. Hans-Christoph Diener of the Neurology Department of Universitat Essen, Germany, and principal investigator of the MATCH trial.
The study results showed that the addition of aspirin had only a limited, statistically non-significant effect on ischemic events.
In addition, the findings showed that aspirin leads to more significant, life-threatening bleedings compared to placebo in patients receiving clopidogrel and other standard therapies.
"If we consider all the clinical data we now have available on the use of clopidogrel in a high-risk population, we can conclude that clopidogrel appears to be the appropriate standard therapy for secondary prevention of stroke, heart attack and vascular deaths in stroke patients," said Dr. Donald Easton, professor and chairman of the Neurology Department of Rhode Island Hospital—Brown Medical School and a member of the Data Safety Monitoring Board.
The study was sponsored by Sanofi-Synthelabo Research and co-funded in the United States by Sanofi-Synthelabo and Bristol-Myers Squibb.