In This SectionTexas Health Research & Education Institute
Disease or Condition
Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke Trial (POINT) (Cardiology)
This study examines whether the combination of low-dose aspirin and clopidogrel increases the effectiveness in reducing the risk of stroke, heart attacks, and other complications in patients who have just had a transient ischemic attack or a minor stroke. The study will also compare the risks of the combination with the risks from aspirin alone.
Neurologic deficit (based on history or exam) attributed to focal brain ischemia and EITHER:
- High risk TIA: Complete resolution of the deficit at the time of randomization AND ABCD2 score >4
-Minor ischemic stroke: residual deficit with NIHSS <3 at the time of randomization.
Ability to randomize within 12 hours of time last known free of new ischemic symptoms.
Head CT or MRI ruling out hemorrhage or other pathology, such as vascular malformation, tumor, or abscess, that could explain symptoms or contraindicate therapy.
Ability to tolerate aspirin at a dose of 50-325 mg/day.
Age <18 years.
TIA symptoms limited to isolated numbness, isolated visual changes, or isolated dizziness/vertigo.
In the judgment of the treating physician, a candidate for thrombolysis, endarterectomy or endovascular intervention, unless the subject declines both endarterectomy and endovascular intervention at the time of the evaluation for eligibility.
Receipt of any intravenous or intra-arterial thrombolysis within 1 week prior to index event.
Gastrointestinal bleed or major surgery within 3 months prior to index event.
History of non-traumatic intracranial hemorrhage.
Clear indication for anticoagulation (e.g., warfarin, heparin) anticipated during the study period (atrial fibrillation, mechanical heart valve, deep venous thrombosis, pulmonary embolism, antiphospholipid antibody syndrome, hypercoagulable state).
Qualifying ischemic event induced by angiography or surgery.
Severe non-cardiovascular comorbidity with life expectancy <3 months.
Contraindication to clopidogrel or aspirin:
- Known allergy.
- Severe renal (serum creatinine >2 mg/dL) or hepatic insufficiency (prior or concurrent diagnosis, with INR>1.5, or any resultant complication, such as variceal bleeding,
encephalopathy, or icterus).
- Hemostatic disorder or systemic bleeding in the past 3 months.
- Current thrombocytopenia (platelet count <100 x109/l) or neutropenia/granulocytopenia (<1 x109/l)
History of drug-induced hematologic or hepatic abnormalities.
Anticipated requirement for long-term (>7 days) nonstudy antiplatelet drugs (eg, dipyridamole, clopidogrel, ticlopidine), or NSAIDs affecting platelet function (such as prior vascular stent or arthritis).
Not willing or able to discontinue prohibited concomitant medications.
Inability to swallow medications.
At risk for pregnancy: premenopausal or postmenopausal woman within 12 months of last menses without a negative pregnancy test or not committing to adequate birth control (e.g., oral contraceptive, two methods of barrier birth control, or abstinence).
Unavailability for follow-up.
Signed and dated informed consent not obtained from patient.
Other neurological conditions that would complicate assessment of outcomes during follow-up.
Ongoing treatment in another study of an investiational therapy, or treatment in such a study within the last 7 days.