Risks and benefits of clopidogrel-aspirin in minor stroke or TIA: Time course analysis of CHANCE.

Document Type

Article

Abstract

OBJECTIVE: To investigate the short-term time course risks and benefits of clopidogrel with aspirin in minor ischemic stroke or TIA.

METHODS: Data were derived from the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. The primary outcome was a new ischemic stroke. Safety outcomes included any bleeding and moderate to severe bleeding. Time course analyses were performed for the outcomes of both stroke and bleeding.

RESULTS: A total of 145 (71.1%), 13 (6.4%), and 12 (5.9%) of 204 new ischemic strokes in the clopidogrel-aspirin group vs 223 (75.6%), 19 (6.4%), and 8 (2.7%) of 295 in the aspirin alone group occurred at the first, second, and third week, respectively. A total of 23 (38.3%), 15 (25.0%), and 9 (15.0%) of 60 bleeding cases in the clopidogrel-aspirin group vs 15 (36.6%), 8 (19.5%), and 3 (7.3%) of 41 in the aspirin alone group occurred at the first, second, and third week, respectively. Clopidogrel-aspirin treatment numerically reduced the risk of ischemic stroke within the first 2 weeks. From the 10th day, the number of any bleeding cases caused by dual antiplatelets outweighed that of new stroke reduced by dual antiplatelets.

CONCLUSIONS: Clopidogrel-aspirin treatment may have a benefit of reducing stroke risk outweighing the potential risk of increased bleeding especially within the first 2 weeks compared with aspirin alone in patients with minor stroke or TIA.

CLINICALTRIALSGOV IDENTIFIER: NCT00979589.

CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for patients with minor stroke or TIA, the reduction of stroke risk from clopidogrel plus aspirin within the first 2 weeks outweighs the risk of bleeding compared with aspirin alone.

Medical Subject Headings

Aspirin; Brain Ischemia; China; Clopidogrel; Double-Blind Method; Drug Therapy, Combination; Fibrinolytic Agents; Humans; Platelet Aggregation Inhibitors; Risk; Stroke; Ticlopidine; Time Factors; Treatment Outcome

Publication Date

5-16-2017

Publication Title

Neurology

ISSN

1526-632X

Volume

88

Issue

20

First Page

1906

Last Page

1911

PubMed ID

28424269

Digital Object Identifier (DOI)

10.1212/WNL.0000000000003941

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