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Randomized Controlled Trial
. 2013 Aug;8(6):479-83.
doi: 10.1111/ijs.12129.

Platelet-oriented inhibition in new TIA and minor ischemic stroke (POINT) trial: rationale and design

S Claiborne Johnston  1 , J Donald Easton, Mary Farrant, William Barsan, Holly Battenhouse, Robin Conwit, Catherine Dillon, Jordan Elm, Anne Lindblad, Lewis Morgenstern, Sharon N Poisson, Yuko Palesch
Affiliations
Randomized Controlled Trial

Platelet-oriented inhibition in new TIA and minor ischemic stroke (POINT) trial: rationale and design

S Claiborne Johnston et al. Int J Stroke. 2013 Aug.

Abstract

Background: Ischemic stroke and other vascular outcomes occur in 10-20% of patients in the three-months following a transient ischemic attack or minor ischemic stroke, and many are disabling. The highest risk period for these outcomes is the early hours and days immediately following the ischemic event. Aspirin is the most common antithrombotic treatment used for these patients.

Aim: The aim of POINT is to determine whether clopidogrel plus aspirin taken <12 h after transient ischemic attack or minor ischemic stroke symptom onset is more effective in preventing major ischemic vascular events at 90 days in the high-risk, and acceptably safe, compared with aspirin alone.

Design: POINT is a prospective, randomized, double-blind, multicenter trial in patients with transient ischemic attack or minor ischemic stroke. Subjects are randomized to clopidogrel (600 mg loading dose followed by 75 mg/day) or matching placebo, and all will receive open-label aspirin 50-325 mg/day, with a dose of 162 mg daily for five-days followed by 81 mg daily strongly recommended.

Study outcomes: The primary efficacy outcome is the composite of new ischemic vascular events - ischemic stroke, myocardial infarction, or ischemic vascular death - by 90 days. The primary safety outcome is major hemorrhage, which includes symptomatic intracranial hemorrhage.

Discussion: Aspirin is the most common antithrombotic given to patients with a stroke or transient ischemic attack, as it reduces the risk of subsequent stroke. This trial expects to determine whether more aggressive antithrombotic therapy with clopidogrel plus aspirin, initiated acutely, is more effective than aspirin alone.

Trial registration: ClinicalTrials.gov NCT00991029.

Keywords: TIA; aspirin; clinical trial; clopidogrel; minor stroke; stroke prevention.

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Figures

Figure 1
Figure 1
Study Flowchart * Open label aspirin (at the discretion of the investigator) with dose of 162 mg daily for 5 days, followed by 81 mg daily for the remaining 85 days, strongly recommended
See this image and copyright information in PMC

Comment in

References

    1. Johnston SC, Fayad PB, Gorelick PB, et al. Prevalence and knowledge of transient ischemic attack among US adults. Neurology. 2003;60(9):1429–1434. - PubMed
    1. Kleindorfer D, Panagos P, Pancioli A, et al. Incidence and short-term prognosis of transient ischemic attack in a population-based study. Stroke; a journal of cerebral circulation. 2005;36(4):720–723. - PubMed
    1. Roger VL, Go AS, et al. Writing Group Members. Heart Disease and Stroke Statistics-2012 Update. Circulation. 2012;125(1):e2–e220. - PMC - PubMed
    1. Alexandrov AV, Felberg RA, Demchuk AM, et al. Deterioration following spontaneous improvement : sonographic findings in patients with acutely resolving symptoms of cerebral ischemia. Stroke; a journal of cerebral circulation. 2000;31(4):915–919. - PubMed
    1. Aslanyan S, Weir CJ, Johnston CS, Krams M, Grieve AP, Lees KR. The association of post-stroke neurological improvement with risk of subsequent deterioration due to stroke events. Eur J Neurol. 2007;14(1):1–6. - PubMed

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