Effect of Estimated Glomerular Filtration Rate Decline on the Efficacy and Safety of Clopidogrel With Aspirin in Minor Stroke or Transient Ischemic Attack: CHANCE Substudy (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events).
Document Type
Article
Abstract
BACKGROUND AND PURPOSE: Patients with chronic kidney disease (CKD) are at a particularly high risk for ischemic and bleeding events. Limited data exist as to the efficacy and safety of clopidogrel in stroke patients with renal dysfunction. Therefore, we sought to assess the impact of decreased kidney function on clinical outcomes for stroke patients on clopidogrel-aspirin treatment.
METHODS: Patients in the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) were randomized to clopidogrel-aspirin or aspirin-alone treatment. The primary efficacy outcome was new stroke during 90 days, whereas bleeding was the safety outcome. Patients were stratified according to estimated glomerular filtration rate.
RESULTS: Dual clopidogrel-aspirin therapy was associated with a marked reduction in new strokes compared with the therapy of aspirin alone in patients with normal renal function (hazard ratio, 0.77; 95% confidence interval, 0.60-0.98; P=0.02) and mild CKD (hazard ratio, 0.60; 95% confidence interval, 0.45-0.79; P
CONCLUSIONS: Clopidogrel plus aspirin could decrease new stroke in patients with normal kidney function and mild CKD, but no extra benefit was observed in those with moderate CKD. Bleeding risk from the dual therapy did not seem to increase in mild or moderate CKD patients.
CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979589.
Medical Subject Headings
Aged; Aged, 80 and over; Aspirin; Cerebral Hemorrhage; Clopidogrel; Comorbidity; Drug Therapy, Combination; Glomerular Filtration Rate; Humans; Ischemic Attack, Transient; Middle Aged; Outcome Assessment, Health Care; Platelet Aggregation Inhibitors; Renal Insufficiency, Chronic; Severity of Illness Index; Stroke; Ticlopidine
Publication Date
11-1-2016
Publication Title
Stroke; a journal of cerebral circulation
ISSN
1524-4628
Volume
47
Issue
11
First Page
2791
Last Page
2796
PubMed ID
27738237
Digital Object Identifier (DOI)
10.1161/STROKEAHA.116.014761
Recommended Citation
Zhou, Yilun; Pan, Yuesong; Wu, Yu; Zhao, Xingquan; Li, Hao; Wang, David Z.; Johnston, S Claiborne; Liu, Liping; Wang, Chunxue; Meng, Xia; Wang, Yilong; and Wang, Yongjun, "Effect of Estimated Glomerular Filtration Rate Decline on the Efficacy and Safety of Clopidogrel With Aspirin in Minor Stroke or Transient Ischemic Attack: CHANCE Substudy (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events)." (2016). Neurology. 1832.
https://scholar.barrowneuro.org/neurology/1832