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Mar 27, 2013

Blood Thinner and Cholesterol Lowering Drug Combination Helps Prevent Stroke After Carotid Stenting

An Italian study finds that high doses of clopidogrel and atorvastatin appear to reduce stroke risk in stent patients.

Carotid stenting is a procedure that opens clogged arteries in the neck to improve blood flow and reduce stroke risk. During carotid stenting, a tiny balloon is used to widen the artery and a small metal coil, called a stent, is inserted to keep the artery open. Although this procedure is one of the best ways to restore normal blood flow in clogged arteries, it is not without risks. But according to a study presented at the 2013 American College of Cardiology Scientific Sessions, a combination of high-dose medications may help reduce risk of complications after carotid stenting.

The ARMYDA-9 CAROTID Study was conducted at two large Italian medical centers to test the use of different doses of an anti-clotting drug, clopidogrel (Plavix), and a cholesterol-lowering medication, atorvastatin (Lipitor), immediately before carotid stenting. A total of 156 patients were enrolled in the study, and they received a combination of either high or low dose clopidogrel six hours before the procedure and either high-dose atorvastatin or no statins 12 hours before the procedure. In general, these drugs have been shown to reduce risk of stroke during stenting, but there are no clear guidelines on what doses are most effective when it comes to carotid stenting specifically—which is why researchers conducted this trial.

What they found was that administering the highest dose (600mg) of clopidogrel and the high dose (80mg + 40mg) of atorvastatin before the procedure was most effective in reducing risk of stroke in the 30 days following the stenting. And importantly, these treatments did not increase risk of bleeding—one of the most common complications associated with anti-clotting medications.

Although more research is needed to better understand the impact of different medication doses on stroke risk, this study helps provide great insight into what doses of drugs should be used before carotid stenting. High-doses of clopidogrel and atorvastatin appear to be most effective in reducing stroke risk, and this combination may soon become the gold-standard for carotid stenting.

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