Should the MATCH Results Be Extrapolated to All Stroke Patients and Affect Ongoing Trials Evaluating Clopidogrel Plus Aspirin?

Abstract

Aspirin alone reduces the risk of recurrent stroke, myocardial infarction (MI), and vascular death by only 13%.1 Clopidogrel was 8% better than aspirin in the CAPRIE trial and was safer with less gastrointestinal bleeding complications.2 For these reasons, clinicians anticipated that the combination of clopidogrel and aspirin would be more effective than either drug alone with the hypothesis that bleeding complications would be only modestly increased. Accordingly, many stroke patients were switched to this combination of therapy, mainly in case of recurrent stroke while on a single antiplatelet agent and in patients with high vascular risk. The results of trials showing the efficacy and tolerance of such an approach after percutaneous coronary intervention was reassuring.3 However, the long-term major bleeding complication rate was unknown except in patients with unstable angina and non-Q wave MI,4 and the net benefit in stroke patients was hypothetical.5 ### The MATCH Trial For this reason, the combination therapy had to be tested for safety and efficacy in a stroke population, and this was the purpose of the MATCH trial.6 MATCH was a secondary prevention trial in patients with ischemic stroke or brain infarction with transient ischemic attack within 3 months of randomization and with 1 of the following entry criteria: diabetes mellitus, past coronary heart disease, recurrent stroke on aspirin, peripheral arterial disease. Aspirin (A) was tested against placebo on the background of clopidogrel (C) in both arms. So it was C+A versus C. As a consequence of the entry criteria stipulating the presence of multiple vascular risk factors, the MATCH population included 70% diabetic subjects, 54% with lacunar stroke (small vessel disease) plus 10% strokes of unknown cause (both at low risk for recurrence). Only 30% of patients had large artery atherosclerotic disease. Few patients (5%) had a past history of coronary …