Aspirin >100 mg/day combined with clopidogrel was associated with a higher risk of ischemic stroke, MI, or death compared to ≤100 mg/day (HR 1.62; 95% CI 1.08-2.42) in TIA or minor stroke patients.
Cohort (n=2,280)
Yes
Does aspirin >100 mg per day compared to ≤100 mg per day improve the composite of ischemic stroke, MI, or death in patients with high-risk TIA or minor ischemic stroke receiving clopidogrel?
In patients with high-risk TIA or minor ischemic stroke receiving clopidogrel, aspirin doses ≤100 mg/day are associated with a lower risk of ischemic events compared to doses >100 mg/day, with no difference in symptomatic intracranial hemorrhage.
Effect estimate: HR 1.62 (95% CI 1.08-2.42)
Absolute Event Rate: 6.6% vs 4.2%
p-value: p=0.03
BACKGROUND: A short-term course of aspirin and clopidogrel has become standard practice in patients with high-risk transient ischemic attacks (TIA)s and minor ischemic stroke, although the appropriate dose of aspirin in such patients is not known. OBJECTIVE: To compare the safety and stroke risk reduction in patients treated with ≤100 mg with those treated with >100 mg per day of aspirin in patients receiving both aspirin and clopidogrel. METHODS: We analyzed data from the patients treated with aspirin and clopidogrel for 90 days in the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial. Patients were treated with aspirin at a dose of 50 to 325 mg per day (as decided by the site investigator) and were dichotomized into patients treated with ≤100 mg and those treated with >100 mg per day for the analysis. We analyzed the effect of aspirin dose on the occurrence of primary composite outcome (composite of ischemic stroke, myocardial infarction MI, or death from an ischemic vascular event) and incident ischemic stroke within 90 days using Cox Proportional Hazards analyses. RESULTS: Aspirin was used as ≤100 mg and >100 mg daily in 1721 and 559 patients, respectively, in addition to 75 mg daily of clopidogrel. Patients who were treated with aspirin >100 mg per day had a higher proportion of patients with hypertension, congestive heart failure, and pre-event use of aspirin. A total of 73 in 1721 and 37 in 559 patients developed the composite endpoint (p = 0.03). In Cox proportional hazards analysis, the risk of primary composite outcome occurrence was significantly higher in patients treated with aspirin >100 mg per day (hazards ratio 1.62, 95% confidence interval 1.08 -2.42) after adjusting for race, hypertension, congestive heart failure, and pre-event use of aspirin. The risk of ischemic stroke occurrence was significantly higher in patients treated with aspirin >100 mg per day (hazards ratio 1.72, 95% confidence interval 1.13-2.60) after adjusting for the above-mentioned confounders. There was no difference in the proportion of patients who developed symptomatic intracranial hemorrhage between the two groups (0.7% versus 0.5%, p = 0.914) CONCLUSIONS: In the POINT study, a lower dose of aspirin showed greater reduction in ischemic stroke, MI, or death when used in combination with clopidogrel in patients with high-risk TIAs or minor ischemic stroke.
Qureshi et al. (2026) conducted a cohort in High-risk TIA and minor ischemic stroke (n=2,280). Aspirin >100 mg per day vs. Aspirin ≤100 mg per day was evaluated on Composite of ischemic stroke, myocardial infarction [MI], or death from an ischemic vascular event (HR 1.62, 95% CI 1.08-2.42, p=0.03). Aspirin >100 mg/day combined with clopidogrel was associated with a higher risk of ischemic stroke, MI, or death compared to ≤100 mg/day (HR 1.62; 95% CI 1.08-2.42) in TIA or minor stroke patients.