Drug Combo May Do More Harm Than Good

Bleeding problems more likely with aspirin and anti-clotting drug

A drug combination commonly used by people who've had a stroke may be more dangerous than helpful, according to recent research.

The combination in question is aspirin and the anti-clotting medication clopidogrel, which is sold under the brand name Plavix.

"It has a small benefit in terms of reducing the risk of another stroke, myocardial infarction [heart attack] or death, but there is a significant increase in bleeding complications," Dr. Hans-Christopher Diener, a professor of neurology at the University of Essen in Germany, told HealthDay .

Diener, who led the research, said this particular combination of drugs is used much more often in the United States than in Europe . Results of the study were first published last year in The Lancet .

The study included more than 7,000 people who had either had a recent stroke or a transient ischemic attack, which is also known as a mini-stroke. Both the strokes and mini-strokes had to have been caused by blood clots for the person to be included in the study. In the case of transient ischemic attacks, the blood clot only temporarily blocks the blood vessel.

All of the study participants already were taking clopidogrel to reduce the chance of new blood clots forming. Half also were given aspirin, which acts as a blood thinner.

The aspirin-clopidogrel group had a slight advantage when it came to stroke, heart attacks, hospitalization for a clotting problem or death. In the combo group, about 16 had such an incident, while about 17 in the clopidogrel-only group did.

However, life-threatening bleeding incidents were twice as frequent in the combination group than in the clopidogrel-only group -- 2.6 percent versus 1.3 percent.

"If you compare the good results with the bad results, it is more or less a wash," Dr. Mark Alberts, a professor of neurology at Northwestern University Medical School , told HealthDay .

He added that the study's findings "should cause physicians to reexamine the practice of using the combination routinely."

But, he said, that doesn't mean there's no use for this combination of medications. It can benefit people who have had a previous heart attack, Alberts said.

"A physician needs to exercise clinical judgment," he explained. "We need to look at the fact that our clinical options are very limited. If you have a patient who fails to benefit from single-agent therapy, the clinician has to consider a combination."

To reduce the risk of stroke in the first place, the American Stroke Association recommends:

• Controlling high blood pressure
• Quitting smoking
• Keeping tight control of blood sugar levels for anyone who's diabetic
• Lowering high cholesterol and triglyceride levels
• Losing weight for anyone who's overweight
• Drinking alcohol only in moderation and avoiding illegal drug use.

All of these things are considered risk factors for stroke. Additionally, regular exercise may help reduce the chances of a stroke.