Historical Reference Page
This is a historical reference page. This trial preceded the modern evidence base. It is presented as a predecessor reference. See POINT (2018) for the modern successor trial that defined the appropriate short-duration window for dual antiplatelet therapy after minor stroke.
MATCH Trial: Management of Atherothrombosis with Clopidogrel in High-Risk Patients
In patients with recent ischemic stroke or TIA with at least one additional vascular risk factor already receiving clopidogrel, does adding aspirin reduce recurrent vascular events over 18 months?
Diener et al. (Lancet 2004) · doi:10.1016/S0140-6736(04)16721-4 · 7,599 patients
Population
Included
- Age 40 years or older
- Recent ischemic stroke (within 3 months) or TIA with at least one additional vascular risk factor
- Currently receiving clopidogrel 75 mg/day
- No contraindication to antiplatelet therapy
Excluded
- Contraindication to aspirin or clopidogrel
- Planned surgical procedure requiring antiplatelet discontinuation
- Active bleeding or high bleeding risk
- Use of warfarin or other anticoagulation
- Severe renal or hepatic impairment
Primary Outcome — Composite (Stroke/MI/Vascular Death/Rehospitalization) at 18 Months
7,599 patients; aspirin added to clopidogrel vs clopidogrel alone; recent stroke or TIA
In 7,599 patients with recent ischemic stroke or TIA plus at least one additional vascular risk factor already receiving clopidogrel, adding aspirin 75 mg/day did not reduce the composite endpoint of ischemic stroke, myocardial infarction, vascular death, or rehospitalization for acute ischemia over 18 months. The primary endpoint occurred in 15.7% of the combination group versus 16.7% of the clopidogrel-alone group (relative risk 0.94, 95% CI 0.84 to 1.05, P=0.244). Major bleeding and life-threatening bleeding were both significantly higher with the combination (2.6% vs 1.3%), establishing that adding aspirin to long-term clopidogrel causes harm without efficacy benefit.
Visualization not shown for predecessor reference pages. See source paper for figures.
Trial Design
MATCH enrolled patients within 3 months of a qualifying ischemic stroke or TIA who had at least one additional vascular risk factor (prior stroke or TIA, diabetes, symptomatic peripheral arterial disease, or ischemic heart disease). All patients were already receiving clopidogrel 75 mg/day and were randomized to aspirin 75 mg/day or matching placebo for 18 months. The comparator arm was clopidogrel monotherapy, not aspirin monotherapy, a critical design difference from CHARISMA. The primary composite endpoint included ischemic stroke, MI, vascular death, and rehospitalization for acute ischemia.
Safety
Life-threatening bleeding occurred in 2.6% of the combination group versus 1.3% of the clopidogrel-alone group (absolute difference 1.3%). Major bleeding was similarly doubled. Fatal and intracranial hemorrhage were both numerically higher with the combination. The net harm of adding aspirin to long-term clopidogrel was unambiguous and statistically significant.