Treatment Effect of Clopidogrel Plus Aspirin Within 12 Hours of Acute Minor Stroke or Transient Ischemic Attack.

Document Type

Article

Abstract

BACKGROUND: The aim of this study was to analyze the benefits and safety associated with the combination therapy of clopidogrel and aspirin among minor stroke or transient ischemic attack patients treated within 12 hours.

METHODS AND RESULTS: This was a subanalysis of the CHANCE (Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events) trial, mainly limited to the prespecified group of patients randomized within 12 hours to either the combination of clopidogrel plus aspirin or aspirin alone. The primary outcome was ischemic stroke during 90-day follow-up. Recurrent ischemic stroke and progressive ischemic stroke were analyzed. Multivariable Cox modeling showed that randomization within 12 hours was an independent predictor of ischemic stroke events (hazard ratio [95% CI] 1.25 [1.04-1.49], P=0.02). Among 2573 patients randomized within 12 hours, 282 (10.96%) patients had ischemic stroke events. Among them, 158 (12.34%) of 1280 patients taking aspirin experienced ischemic stroke compared with 124 (9.59%) of 1293 patients taking clopidogrel-aspirin (P=0.02). The dual antiplatelet was more effective than aspirin alone in reducing the risk of recurrent ischemic stroke (6.57% versus 8.91%, P=0.03) but not progressive ischemic stroke (3.02% versus 3.43%, P=0.28). There was no significant difference in hemorrhagic events (P=0.39).

CONCLUSIONS: Among patients treated within 12 hours, the combination of clopidogrel and aspirin was more effective than aspirin alone in reducing the risk of recurrent ischemic stroke during the 90-day follow-up and did not increase the hemorrhagic risk.

CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00979589.

Medical Subject Headings

Aged; Aspirin; Chi-Square Distribution; China; Clopidogrel; Disease Progression; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Hemorrhage; Humans; Ischemic Attack, Transient; Male; Middle Aged; Multivariate Analysis; Platelet Aggregation Inhibitors; Proportional Hazards Models; Prospective Studies; Recurrence; Risk Factors; Secondary Prevention; Severity of Illness Index; Stroke; Ticlopidine; Time Factors; Time-to-Treatment; Treatment Outcome

Publication Date

3-21-2016

Publication Title

J Am Heart Assoc

ISSN

2047-9980

Volume

5

Issue

3

First Page

003038

Last Page

003038

PubMed ID

27001965

Digital Object Identifier (DOI)

10.1161/JAHA.115.003038

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