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Clopidogrel cessation after atrial-septal-defect repair doesn’t boost migraine risk

JAMA Cardiology
Reuters Health - 02/10/2020 - Withdrawal of clopidogrel from patients undergoing dual antiplatelet therapy following transcatheter atrial-septal defect (ASD) closure does not increase the risk of new-onset migraine attacks, according to new research.

"It is well known that adding clopidogrel to aspirin for three months after transcatheter ASD closure results in a lower incidence of new-onset migraine attacks," Dr. Josep Rodes-Cabau of Laval University, in Quebec City, Canada, explained in an email to Reuters Health.

"Our current study," he said, "showed that migraine attacks post-ASD closure improved/resolved spontaneously within six to 12 months in most patients. No significant rebound effect was observed after clopidogrel cessation at three months."

In a paper in JAMA Cardiology, Dr. Rodes-Cabau and colleagues note that about 15% of patients present with new-onset migraine headaches within days or weeks following ASD.

In the CANOA trial, which included 171 patients randomized to receive dual-antiplatelet therapy with aspirin plus clopidogrel or single-antiplatelet therapy with aspirin plus placebo, addition of clopidogrel was shown to reduce migraine at three months. The incidence was 9.5% in the dual antiplatelet group and 21.8% in those given aspirin and placebo.

In the current prespecified analysis of data from that trial, the researchers found that at six and 12 months after clopidogrel withdrawal most migraine headaches had partially or completely resolved.

At 12 months, only 2.3% of patients - including about 10% of the patients with migraine episodes within the first three months - continued to have persistent migraine headaches and these entailed no or only mild disability. "Importantly," say the researchers, only one patient in each group had new-onset migraine after the first three months.

"These results demonstrate a low rate of migraine events beyond three months following transcatheter ASD closure, and support the early discontinuation of clopidogrel after the procedure," concluded Dr. Rodes-Cabau.

By David Douglas

SOURCE: https://bit.ly/3n7vHqX JAMA Cardiology, online September 23, 2020.

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