Clopidogrel Plus Aspirin in Patients With Different Types of Single Small Subcortical Infarction

Authors

Guangyao Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Xiaomeng Yang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Jing Jing, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Xingquan Zhao, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Liping Liu, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Chunxue Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
David Wang, Neurovascular Division, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States.Follow
Anxin Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Xia Meng, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Yongjun Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Yilong Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Document Type

Article

Abstract

We aim to investigate the effects and safety of clopidogrel plus aspirin in patients with different types of single small subcortical infarction (SSSI) in the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. SSSI was defined as single DWI lesion of ≤2.0 cm. Patients with SSSI were divided into SSSI + PAD (parent artery disease) and SSSI - PAD, according to the stenosis of the parent artery. The efficacy outcome was stroke recurrence during 90-day follow-up. Cox proportional hazards models or logistic regression models were used to assess the interaction of the treatment effects of clopidogrel plus aspirin vs. aspirin alone among patients with and without PAD. Among 338 patients with SSSI included in the subanalysis, 105 were with PAD and 233 without. The efficacy of clopidogrel plus aspirin compared with aspirin alone on any stroke was consistent between patients with [adjusted hazard ratio (HR) 0.84; 95% confidence interval (CI), 0.25-2.75] and without PAD (adjusted HR 1.03; 95% CI, 0.40-2.68, interaction = 0.83). In patients with SSSI + PAD, the rate of stroke recurrence in those treated with dual antiplatelet therapy and mono antiplatelet therapy was not significantly different (10.9 vs. 13.6%, = 0.77). The number of bleeding events was similar between the clopidogrel-aspirin group and aspirin group regardless of SSSI + PAD or SSSI - PAD. There was no significant difference in the efficacy of clopidogrel plus aspirin compared with aspirin alone between patients with SSSI + PAD and SSSI - PAD in the CHANCE trial. Studies in other populations and with adequate power are needed to further verify such findings.

Publication Date

1-1-2021

Publication Title

Frontiers in neurology

ISSN

1664-2295

Volume

12

First Page

631220

PubMed ID

33854474

Digital Object Identifier (DOI)

10.3389/fneur.2021.631220

Recommended Citation

Wang, Guangyao; Yang, Xiaomeng; Jing, Jing; Zhao, Xingquan; Liu, Liping; Wang, Chunxue; Wang, David; Wang, Anxin; Meng, Xia; Wang, Yongjun; and Wang, Yilong, "Clopidogrel Plus Aspirin in Patients With Different Types of Single Small Subcortical Infarction" (2021). Neurology. 1774.
https://scholar.barrowneuro.org/neurology/1774