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Stroke, 2019. 50(1), 101-109, DOI: https://doi.org/10.1161/STROKEAHA.118.022691
Comparative effectiveness of aspirin and clopidogrel versus aspirin in acute minor stroke or transient ischemic attack
Joon-Tae Kim, Man-Seok Park.MD.PhD; Kang-Ho Choi.MD.PhD; Ki-Hyun Cho.MD.PhD;Beom Joon Kim.MD.PhD; Jong-Moo Park.MD.PhD; Kyusik Kang.MD.PhD; Soo Joo Lee.MD.PhD;Jae Guk Kim.MD; Jae-Kwan Cha.MD.PhD; Dae-Hyun Kim.MD.PhD; Hyun-Wook Nah.MD.PhD Tai Hwan Park; MD; PhD; Sang-Soon Park; MD; Kyung Bok Lee; MD; PhD; Jun Lee; MD; PhD; Keun-Sik Hong; MD; PhD; Yong-Jin Cho; MD; PhD; Hong-Kyun Park; MD; Byung-Chul Lee; MD; PhD; Kyung-Ho Yu; MD; PhD; Mi Sun Oh; MD; PhD; Dong-Eog Kim; MD; PhD; Wi-Sun Ryu; MD; Jay Chol Choi; MD; PhD; Jee-Hyun Kwon; MD; PhD; Wook-Joo Kim; MD; PhD; Dong-Ick Shin; MD; PhD; Min-Ju Yeo; MD; Sung Il Sohn; MD; PhD; Jeong-Ho Hong; MD; PhD; Ji Sung Lee; PhD; Juneyoung Lee; PhD; Jeffrey L. Saver; MD; S. Claiborne Johnston; MD; PhD; Hee-Joon Bae; MD; PhD
Background and Purpose
This study aimed to compare the effectiveness of dual antiplatelet therapy with clopidogrelaspirinto that of aspirin monotherapy in patients with acute minor cerebral ischemia using a prospective, nationwide,multicenter, stroke registry database in South Korea.
CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events)-likepatients who met eligibility criteria modeled on the CHANCE trial eligibility criteria, including (1) acute minor ischemicstroke defined as National Institutes of Health Stroke Scale score ≤3 or lesion positive transient ischemic attack within 24 hours of onset and (2) noncardioembolic stroke mechanism. Propensity scores using the inverse probability of treatmentweighting was used to adjust for baseline imbalances. The primary outcome was the composite of all stroke (ischemicand hemorrhagic), myocardial infarction, and vascular death by 3 months.
Among 5590 patients meeting the eligibility criteria, age was 64 ±13 year and 62.6% were male. Aspirin and combinationof clopidogrel-aspirin were administered in 66.1% and 33.9% of patients, respectively. In unadjusted analysis, rates of the3-month primary vascular event outcome were lower with clopidogrel-aspirin versus aspirin, 9.9% versus 12.2% (hazardratio, 0.79 [0.67–0.95]). In propensity-weighted Cox proportional hazards regression with robust estimation, clopidogrelaspirinwas associated with a lower risk of the primary vascular event outcome (hazard ratio, 0.76 [0.63–0.92]) and allstroke events (hazard ratio, 0.74 [0.61–0.90]). Among 6 predefined subgroup analyses, 3 showed potential modification oftreatment effect, with lesser benefit associated with the absence of prior antiplatelet use (Pinteraction=0.01) and younger age(<75 years, Pinteraction=0.07), and absence of benefit associated with small vessel occlusion subtype (Pinteraction=0.08).
Dual antiplatelet therapy with aspirin and clopidogrel was associated with reduced stroke, myocardialinfarction, and vascular death in the 3 months following a presenting minor, noncardioembolic ischemic stroke. Benefitsmay be particularly magnified in patients with a history of prior antiplatelet therapy, older age, and nonsmall vesseldisease stroke mechanism.
- DOI: https://doi.org/10.1161/STROKEAHA.118.022691
- ISBN or ISSN: 0039-2499
- 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
- This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.