Impact of Aspirin versus Clopidogrel Treatment on the Prevention of Recurrent Events in Patients with Ischemic Stroke

Ischemic stroke is a leading cause of global morbidity and mortality. Secondary prevention is essential to reduce the recurrence of events. This study compares the efficacy and safety of aspirin versus clopidogrel in preventing recurrent events in patients with ischemic stroke. A systematic review and meta-analysis of randomized controlled trials published between 2004 and 2024 was conducted. Studies comparing aspirin and clopidogrel in adult patients with ischemic stroke were included. Eleven studies involving 77,216 patients were analyzed. Clopidogrel significantly reduced the recurrence of stroke compared to aspirin (RR 0.86; 95% CI, 0.75–0.98). No significant differences were found in the rate of serious adverse events between the two treatments. Clopidogrel, as monotherapy, proves to be more effective than aspirin in preventing recurrent events in patients with ischemic stroke, without a significant increase in severe adverse events. However, dual therapy may offer additional benefits for some patients, albeit at the cost of an increased risk of bleeding. These findings suggest that clopidogrel is a preferred option for secondary prevention, with careful assessment of the risk-benefit profile in specific cases.