AHA 2015: Combination therapy reduces migraine rate after cardiac procedure

by Bruce Sylvester: Transcatheter atrial septal defect (ASD) closure patients treated with clopidogrel and aspirin instead of aspirin alone have achieved a lower monthly frequency of migraine attacks, researchers reported on Nov. 9, 2015 at the American Heart Association Scientific Sessions 2015. The study was published simultaneously in JAMA, the Journal of the American Medical Association.

New-onset migraine appears in about 15 percent of patients after transcatheter ASD closure, and aspirin is usually prescribed for 6 months.

Josep Rodes-Cabau, M.D., of Laval University, Quebec City, Canada, and colleagues randomized 171 subjects with atrial septal defect (ASD) closure and no migraine history to receive aspirin plus clopidogrel (n = 84) or aspirin plus placebo (n = 87) for 3 months after transcatheter ASD closure. The first patient was enrolled in December 2008, and researchers completed the last follow-up in February 2015.

Mean age of the participants was 49 (+ /- 15) years, and 62 percent (106) were women.

The primary efficacy outcome was total monthly number of migraine days within the 3 months following ASD closure.

The researchers reported that subjects in the clopidogrel plus aspirin group achieved a statistically significantly lowewr average number of monthly migraine days during the 3 months following the procedure, (0.4 days) vs the aspirin-only group (1.4 days, p=.04).

The dual therapy group also achieved a lower incidence of migraine attacks, 9.5 percent vs 22 percent for the aspirin-only group.

Notably, among all subjects who had migraine, none in the clopidogrel plus aspirin group had moderate-to-severe migraine vs 37 percent, 7 patients, in the aspirin only group.

There was no significant increase in adverse events related to the addition of clopidogrel.

“Among patients who underwent transcatheter ASD closure, the use of clopidogrel and aspirin, compared with aspirin alone, resulted in a lower monthly frequency of migraine attacks over 3 months. Further studies are needed to assess generalizability and durability of this effect,” the authors concluded.