MATCH (acute ischemic stroke)
Trial question
What is the role of aspirin and clopidogrel in high-risk patients with recent ischemic stroke or TIA?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
37.0% female
63.0% male
N = 7599
7599 patients (2821 female, 4778 male).
Inclusion criteria: high-risk patients with recent ischemic stroke or TIA and at least one additional vascular risk factor who were already receiving clopidogrel 75 mg/day.
Key exclusion criteria: age < 40 years, severe comorbid conditions, increased risk of bleeding, scheduled for major surgery or vascular surgery, and contraindications for aspirin or clopidogrel.
Interventions
N=3797 aspirin (75 mg/day).
N=3802 placebo (matching placebo daily).
Primary outcome
Ischemic stroke, MI, vascular death, or rehospitalization for acute ischemia
15.7%
16.7%
16.7 %
12.5 %
8.3 %
4.2 %
0.0 %
Aspirin
Placebo
No significant
difference ↔
No significant difference in ischemic stroke, MI, vascular death, or rehospitalization for acute ischemia (15.7% vs. 16.7%; RR 0.94, 95% CI 0.84 to 1.05).
Secondary outcomes
No significant difference in MI, ischemic stroke, or vascular death (12% vs. 12%; RR 0.94, 95% CI 0.83 to 1.07).
No significant difference in death from any cause (5% vs. 5%; RR 0.99, 99% CI 0.79 to 1.18).
Safety outcomes
Significant difference in life-threatening bleedings (2.6% vs. 1.3%) and major bleeds (1.12% vs. 0.29%).
Conclusion
In high-risk patients with recent ischemic stroke or TIA and at least one additional vascular risk factor who were already receiving clopidogrel 75 mg/day, aspirin was not superior to placebo with respect to ischemic stroke, MI, vascular death, or rehospitalization for acute ischemia.
Reference
Diener HC, Bogousslavsky J, Brass LM et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004 Jul 24-30;364(9431):331-7.
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