Xianwei Wang1, Xingquan Zhao1, S Claiborne Johnston1, Ying Xian1, Bo Hu1, Chunxue Wang1, David Wang1, Liping Liu1, Hao Li1, Jiming Fang1, Xia Meng1, Anxin Wang1, Yongjun Wang1, Yilong Wang2. 1. From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada. 2. From the Department of Neurology (X.W., X.Z., C.W., L.L., H.L., X.M., A.W., Yongjun Wang, Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco; Duke Clinical Research Institute (DCRI) (Y.X.), Duke University, Durham, NC; the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, OH; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Institute for Clinical Evaluative Sciences (J.F.), Toronto, Canada. yilong528@gmail.com yongjunwang1962@gmail.com.
Abstract
OBJECTIVE: We compared the effect of clopidogrel plus aspirin vs aspirin alone on functional outcome and quality of life in the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial ofaspirin-clopidogrel vs aspirinalone after acute minor stroke or TIA. METHODS: Participants were assessed at 90 days for functional outcome using the modified Rankin Scale (mRS) and quality of life using the EuroQol-5 Dimension (EQ-5D). Poor functional outcome was defined as mRS score of 2-6 at 90 days and poor quality of life as EQ-5D index score of 0.5 or less. RESULTS:Poor functional outcome occurred in 254 patients (9.9%) in the clopidogrel-aspirin group, as compared with 299 (11.6%) in the aspirin group (p = 0.046). Poor quality of life occurred in 142 (5.5%) in the clopidogrel-aspirin group and in 175 (6.8%) in the aspirin group (p = 0.06). Disabling stroke at 90 days occurred in 166 (6.5%) in the clopidogrel-aspirin group and in 219 (8.5%) in the aspirin group (p = 0.01). In stratified analysis by subsequent stroke, there was no difference in 90-day functional outcome and quality of life between the 2 groups. CONCLUSIONS: In patients with minor stroke or TIA, the combination of clopidogrel and aspirin appears to be superior to aspirin alone in improving the 90-day functional outcome, and this is consistent with a reduction in the rate of disabling stroke in the dual antiplatelet arm. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for patients with acute minor stroke or TIA, clopidogrel plus aspirin compared to aspirin alone improves 90-day functional outcome (absolute reduction of poor outcome 1.70%, 95% confidence interval 0.03%-3.42%).
RCT Entities:
OBJECTIVE: We compared the effect of clopidogrel plus aspirin vs aspirin alone on functional outcome and quality of life in the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial of aspirin-clopidogrel vs aspirin alone after acute minor stroke or TIA. METHODS:Participants were assessed at 90 days for functional outcome using the modified Rankin Scale (mRS) and quality of life using the EuroQol-5 Dimension (EQ-5D). Poor functional outcome was defined as mRS score of 2-6 at 90 days and poor quality of life as EQ-5D index score of 0.5 or less. RESULTS: Poor functional outcome occurred in 254 patients (9.9%) in the clopidogrel-aspirin group, as compared with 299 (11.6%) in the aspirin group (p = 0.046). Poor quality of life occurred in 142 (5.5%) in the clopidogrel-aspirin group and in 175 (6.8%) in the aspirin group (p = 0.06). Disabling stroke at 90 days occurred in 166 (6.5%) in the clopidogrel-aspirin group and in 219 (8.5%) in the aspirin group (p = 0.01). In stratified analysis by subsequent stroke, there was no difference in 90-day functional outcome and quality of life between the 2 groups. CONCLUSIONS: In patients with minor stroke or TIA, the combination of clopidogrel and aspirin appears to be superior to aspirin alone in improving the 90-day functional outcome, and this is consistent with a reduction in the rate of disabling stroke in the dual antiplatelet arm. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for patients with acute minor stroke or TIA, clopidogrel plus aspirin compared to aspirin alone improves 90-day functional outcome (absolute reduction of poor outcome 1.70%, 95% confidence interval 0.03%-3.42%).
Authors: Dawn Kleindorfer; Peter Panagos; Arthur Pancioli; Jane Khoury; Brett Kissela; Daniel Woo; Alexander Schneider; Kathleen Alwell; Edward Jauch; Rosie Miller; Charles Moomaw; Rakesh Shukla; Joseph P Broderick Journal: Stroke Date: 2005-02-24 Impact factor: 7.914
Authors: S Claiborne Johnston; J Donald Easton; Mary Farrant; William Barsan; Holly Battenhouse; Robin Conwit; Catherine Dillon; Jordan Elm; Anne Lindblad; Lewis Morgenstern; Sharon N Poisson; Yuko Palesch Journal: Int J Stroke Date: 2013-08 Impact factor: 5.266
Authors: Shadi Yaghi; Sara K Rostanski; Amelia K Boehme; Sheryl Martin-Schild; Alyana Samai; Brian Silver; Christina A Blum; Mahesh V Jayaraman; Matthew S Siket; Muhib Khan; Karen L Furie; Mitchell S V Elkind; Randolph S Marshall; Joshua Z Willey Journal: JAMA Neurol Date: 2016-05-01 Impact factor: 18.302