Kumar S et al. (2006) Antiplatelets, ACE inhibitors, and statins combination reduces stroke severity and tissue at risk. Neurology 66: 1153–1158

Antiplatelet agents, angiotensin-converting-enzyme inhibitors and statins are well known to be effective in stroke prevention. A retrospective study by researchers at the Beth Israel Deaconess Medical Center has shown that, if these drugs are used in combination prior to stroke, stroke severity might be reduced further and the volume of ischemic tissue at risk decreased.

All patients in the study presented within 24 h of stroke onset. The 20 patients on all three stroke prevention therapies at stroke onset had a significantly lower NIS Stroke Scale score (P = 0.001) and smaller perfusion–diffusion mismatch lesion volumes—indicating smaller volumes of ischemic tissue at risk—than the 43 patients on an antiplatelet agent plus a statin or angiotensin-converting-enzyme inhibitor, the 47 patients on antiplatelets alone, and the 69 patients taking no stroke treatment. Patients taking triple therapy were also more likely to have a shorter length of hospital stay and better functional status upon discharge, although this was probably due to differences in the initial severity of stroke rather than differences in the effect of the treatments on recovery.

The authors state that the additive effects of the combined therapies are probably caused by their differing modes of action. The findings of this study are preliminary and cannot lead directly to a recommendation for triple therapy in all patients at risk for stroke, but they nevertheless provide an important basis for further investigation.