Stopping the Slide: Clopidogrel’s Edge in Moderate Stroke

Key Takeaway

In a 2,915-patient analysis from the ATAMIS trial, adding clopidogrel to aspirin cut the odds of a stroke worsening during its first week by about 69% in patients with moderate stroke. It made no measurable difference for patients with mild stroke. Bleeding and brain hemorrhage over 90 days were no more common with the 2-drug combination in either group, which suggests that how severe a stroke is on arrival should help decide which pills a patient receives.

The Stroke That Doesn’t Stop at the Door

Picture a 67-year-old retired machinist who wakes on a Tuesday with a clumsy right hand and words that come out thick and slow. In the emergency department, the neurologist scores him a 7 on the National Institutes of Health Stroke Scale. This 0-to-42 checklist rates weakness, speech, vision and sensation, and higher numbers mean more damage. He is alert and talking, and his family is relieved. By Thursday he cannot lift his arm off the bed.

Neurologists call this early neurological deterioration. It is a stroke that keeps advancing after the patient has reached the hospital,…